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3 Lessons from Other Systems
Pages 37-50

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From page 37...
... Interagency Program Office and assistant deputy surgeon general for Total Force Integration, introduced the three speakers: Kenneth W Kizer, former under secretary for health in the VA and former director of the California Department of Health Services; John Holcomb, director of the Division of Acute Care Surgery at the University of Texas Health Science Center at Houston and former trauma consultant for the U.S.
From page 38...
... Kizer focused the rest of his talk on the efforts that have been made by the VA to regionalize a number of its services. He noted that the veterans health care system was established circa World War I and is the largest health care system in the country -- albeit an anomaly in that it is a national, centrally administered, government-run, and government-funded care delivery system based on a moral or philosophical view that those who have served in the nation's armed forces should not be denied health care regardless of financial status.
From page 39...
... More recently, cardiac care has been regionalized in the VA, and quite recently the system has adopted a regionalized approach to treating multiple sclerosis and Parkinson's disease. The VA has also regionalized traumatic brain injury in concert with both the DOD and the private sector.
From page 40...
... System-level quality management, Kizer said, is very different from managing quality at a single facility or a single service within a facility. Data collection requires that data elements be standardized and that many different sources of information come together in a seamless manner, to be shared bi-directionally.
From page 41...
... Army Institute of Surgical Research and trauma consultant for the Army surgeon general, discussed the Joint Theater Trauma System. He said that after visiting Iraq in 2003 to assess the military's trauma system, he briefed the Army surgeon, and told him: "Sir, we do not have a trauma system.
From page 42...
... It does not provide prospective randomized data, but it works effectively in combination with experience and opinion. The military has also disseminated clinical practice guidelines and, more importantly, conducted weekly telephone conferences to review cases.
From page 43...
... . We're able to do all Current Route from Injury to Definitive Care CASEVAC TACTICAL 1 Hour EVAC 1-24 Hours BAS Level 1 STRATEGIC EVAC 24-72 Hours Forward Surgical Combat Suppor t Hospital, teams EMEDS, Fleet Hospital Level 2 Level 3 Definitive Care Definitive Care Level 4 Level 5 Surgical Capability Pushed Forward FIGURE 3-1 Care delivery in the military's joint theater trauma system.
From page 44...
... Summarizing, Holcomb said, "The DOD has evolved an effective system of communication and regionalization of trauma care, which has become the standard of care on the battlefield." ACCOUNTABLE CARE ORGANIZATIONS David Magid, director of research for the Colorado Permanente Medical Group, discussed the need for improved systems of care. He referenced the 2001 Institute of Medicine's report, Crossing the Quality Chasm, which talked about how patients encounter multiple professionals across multiple different settings.
From page 45...
... Magid said had this patient been brought by EMS to Accountable General Hospital, medical records would have revealed that the patient has had multiple visits for chest pain. A stress test was conducted six months ago and the readings were found to be normal, and a catheterization had been performed three months ago and was also shown to be normal.
From page 46...
... Kizer called the early days of the trauma care system in Los Angeles County a good case study of what not to do. When initially setting up its trauma system in the early 1980s, the Los Angeles County Board of Supervisors chose not to abide by expert advice.
From page 47...
... , but to make sure all the other sites remain capable not only on a day-to-day basis but in a surge capacity." Post-Acute Trauma Care Ellen MacKenzie, a panelist from session one, said we've shown we can save lives by regionalizing trauma care and we spent a lot of time this morning talking about that. But it's also important for us to remember that one major study showed that among 2,500 people who were working up
From page 48...
... So while we have developed great models of trauma care in the civilian world and even more so in military, we still haven't fixed the problem of what happens after patients leave the trauma center or the trauma system, she said. Kizer noted that the VA system has nurtured vocational rehabilitation, job training, and other dimensions of care as a key part of their regionalized approach.
From page 49...
... 2009. PowerPoint slides presented at the Regionalizing Emergency Care Workshop, Washington, DC.


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