BRAVe Home Meds (Boxed, Reconciled, Assistance at Veterans Home for Medications)
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Our goal is to improve the quality of care for older Veterans while reducing costs. Currently, VA Eastern Colorado Health Care System spends more than $3 million dollars annually through Community Care for externally contracted home health RNs to fill medication pill boxes.
To address this, we’ve introduced BRAVe Home Meds, which leverages existing VA infrastructure by deploying VA-employed LPNs (Licensed Practical Nurses) to visit Veterans' homes. These visits include medication management, health assessments, med box filling, and video consultations with geriatricians. By shifting to this model, BRAVe is projected to reduce VA costs by 30-50% for the medication management service.
Origin:
September 2021, Rocky Mountain Regional VA Medical Center (Aurora Rocky Mountain)
Adoptions:
1 in-progress
Awards and Recognition:
GRECC Clinical Innovation
Partners:
Geriatric Research Education and Clinical Center, Geriatrics and Extended Care, Office of Community Care
Recent Updates
Overview
The problem
VA Geriatricians identified challenges in continuity of care, particularly in coordinating VA medication orders with home health nurses. To address these issues, discussions began with Geriatric fellows, Office of Community Care (OCC), the Patient Aligned Care Team (PACT), Pharmacy, Nursing, and Systems Redesign. A chart review analyzed the characteristics of Veterans using home medication management. We found that these Veterans tend to be elderly, vulnerable, lacking support in the home, and often have symptoms of dementia. We also found that there was a significant amount of low yield administrative burden on VA staff for this service.
Our multidisciplinary team designed an effective solution within the VA system while establishing collaborative processes for cost reduction. This proactive approach can reduce overall healthcare costs for the VA by preventing the need for expensive acute care services. See more
The solution
How much do we spend on this service? Reconciling medication management costs with current financial data sources is difficult at best. We do not pay one amount for same service for every patient. To make this even more complex, home medication management consults are under the consult title “Community Care-GEC Skilled Home Care,” which lacks a stand-alone medication management category. This consult encompasses a range of services, including physical therapy, occupational therapy, speech therapy, wound management, and catheter care, making it difficult to isolate medication management alone. To address this, our team introduced the hashtag #MM# to specifically categorize medication management consults on the backend. This innovation led to the creation of a PowerBI dashboard, enabling VA staff to quickly locate Veterans with medication management consults and quantify the resources spent on this service. By implementing #MM#, we leverage the hashtags to correlate clinical information from the chart with the financial data resources, thus demonstrating the necessity of BRAVe. See more
Images
Above:
The HASHTAG Solution enables concise tracking of medication management consults (Image Credit - Dr. Audrey Yee)
The results
Most importantly, BRAVe brings VA staff directly into Veterans' homes for safe medication management. When one Veteran urgently needed to stop taking a medication before surgery, the VA nurse was able to schedule a home visit to ensure coordination and avoid cancellation. Another Veteran avoided an ER trip entirely thanks to outreach from the BRAVe team. The image below illustrates a situation where the BRAVe nurse was able to discard unsafe and expired medications from a Veteran’s home due to the trusting relationship that was established. These successes showcase how bringing VA staff into Veterans' homes can transform medication management and delivery of care. See more
Images
Above:
BRAVe Home Meds improves patient safety (Image credit - Dr. Sarah Beck)
Above:
BRAVe vs. Home Health Program Cost Estimates for ~150 Veterans Enrollment (Image Credit: Robyn Moon, GRECC RN)
Metrics
- Number of Veterans served - ECHCS provides medication management services to over 600 unique Veterans annually
- Cost offset - BRAVe can provide medication management at lower cost to VA
- Patient satisfaction scores - increased with BRAVe providing medication management!
- Count and categories of Veteran connections to VA services
- Decreased administrative burden for VA staff
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
Above:
Quotes from Veterans regarding BRAVe staff and services (Image Credit - Lynette Kelley, NP)
Above:
Veteran surveys show VA can do it better! (Image Credit - Lynette Kelley, NP)
Implementation
Timeline
-
1 month
Identify geriatrician medical director and field team (1 RN and 4 LPNs/ICTs) who will participate in the program (if you need to create new positions expect this step to take 6-9 months). -
1 month
Develop workflow for identifying eligible utilizers of medication management only and implement use of THE HASHTAG SOLUTION (#MM# in community care consult processing). -
1 month
Work with Clinical Application specialists to create consult and import electronic template notes and test for local usability. -
1-2 months
Conduct BRAVe orientation to include: home visit procedures, mandatory TMS modules, Prevention & Management of Disruptive Behavior (PMDB), and training home visit with experienced VA staff member. Complete tele-work agreements for field team and obtain necessary IT equipment and access (laptops, iPhones, remote printing). Order medical bags and collect supplies. We locally "nested" BRAVe adjacent to our Home Based Primary Care Service, this structure allowed for home safety and Joint Commission standards to be easily accommodated. -
1-3 months
Enroll Veterans and start doing home visits!
Departments
- Community Care
- Home Based Primary Care
- Nursing services
- Geriatrics
Core Resources
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Contact
About
Origin story
Original team
Sarah Beck
Physician (GRECC & Medicine-Geriatrics)
Robyn Moon
GRECC, Clinical Innovation Nurse
Audrey Yee
Office of Community Care, Home Health Section Chief/Geriatric & Extended Care
Sandra Malakauskas
Former Section Chief-Office of Community Care, Home Health
Tamatha Anding
Office of Community Care, Home Health Asst. Nurse Manager/Geriatric & Extended Care
Mercy Tekle
Licensed Practical Nurse, GRECC Researcher
Lauren Abbate
Physician, (GRECC Associate Director for Clinical Innovations & Emergency Department)
Lynette Kelley
GRECC, Nurse Practitioner/Clinical Analyst
Comment
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