Presentation Abstract

Title — Tackling Prevention Disparities in an Integrated Healthcare System: Lessons from the VA

Background: The Veterans Health Administration is a national, integrated healthcare system serving more than 9 million Veterans. Since reforms in the 1990’s, the VA has become a leader in promoting preventive care, aided by more than 2 decades of experience with the electronic health record, national programs to combat tobacco and alcohol, expanded primary care teams, and an emphasis on behavioral health. Eliminating disparities is also a central commitment of the VA, due to its mission to serve all who have served. As such, VA is a valuable laboratory to examine what can be accomplished, and what challenges remain, in providing high quality preventive care to all populations.  Objectives: This talk will review a variety of VA efforts to promote preventive care across issues of primary, secondary (screening) and tertiary prevention. I will review progress, evidence of where disparities continue to be observed, and findings about the sources of those disparities.  Results:  In most areas of prevention, the VA outperforms the private sector and has smaller disparities based on race/ethnicity.  Nonetheless, some disparities still exist, and they are most common in areas where social determinants of health are most important. Effective progress has relied on a combination of leadership commitment, performance measurement, clinical decision support, national policies, and redesigned clinical care.   Additional work needs to be done to involve the community as well as the health system, to improve health literacy, and promote patient activation around behavior change.  Conclusions:  A combined system approach that integrates high level leadership, national policies and clinical programs, local performance measurement, provider tools, and team-based care can improve prevention and narrow disparities. Health care systems, however, need better partnerships with patients and their communities to tackle prevention issues, especially related to healthy behaviors. 

About Dr. Atkins

David Atkins is Director of the U.S. Department of Veterans Affairs’ Health Services Research and Development (HSR&D) Service, a position he began in 2013. Trained in general internal medicine, his interests have focused on the intersection between research evidence, clinical and public policy, and health system improvement. He has written widely about standards of evidence and the role of evidence in guidelines, performance measures, policy, and system change. 

In his current role at HSR&D, Dr. Atkins oversees a more than $100 million intramural health services research program, with more than 600 funded investigators and 245 ongoing research projects aimed at improving the health and care of veterans. Dr. Atkins joined the VA in 2008, serving until 2012 as Director of HSR&D’s Quality Enhancement Research Initiative (QUERI), which focuses on implementation of evidence-based innovations to improve health care for veterans. For much of 2016, he served as the Veterans Health Administration’s Acting Chief Research and Development Officer, overseeing all four research services in the Office of Research and Development.

Before joining the VA, Dr. Atkins spent more than a decade at the Agency for Healthcare Research and Quality (AHRQ) and 3 years at the Office of Disease Prevention and Health Promotion as Senior Advisor for the U.S. Preventive Services Task Force, co-directing a national task force on clinical prevention convened by the U.S. Assistant Secretary for Health. Dr. Atkins received his M.D. from Yale University, is board certified in internal medicine, and has a Masters of Public Health in epidemiology from the University of Washington.

Dr. Atkins did not disclose any conflicts of interest for this workshop.