Jan Dyer

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

Native American veterans have the highest rate of posttraumatic stress disorder (PTSD) of any ethnic group and often face significant barriers to care, such as living in rural and remote areas. To help overcome those barriers, the Office of Rural Health (ORH) established its Native Domain, a national resource on health care issues for rural Native veterans.

The Native Domain’s Telemental Health Services provides ongoing mental health care—including medication management, case management, and individual, group, and family psychotherapy—via videoconferencing to veterans who live on or near rural American Indian reservations in Montana, Wyoming, and South Dakota.

This “unique service within the VA system” demonstrates an “innovative model,” according to the ORH. Studies have suggested that telemental health is as effective as face-to-face services. For example, a 2010 study of 125 veterans with PTSD found videoconferencing an “effective and feasible” way to increase access to evidence-based care.

Clinic staff include VA-employed Tribal Outreach Workers (TOWs), who are usually military veterans and members of the tribes they serve. Their varied duties range from helping Native veterans enroll in the clinic programs, showing patients how to use the videoconferencing equipment, troubleshooting clinic telecommunications equipment, to coordinating emergency crisis management. The TOWs also work closely with the remote clinicians and provide guidance on cultural and community issues that may be relevant to the patient’s care or treatment.

The American Indian Telemental Health video (www.ruralhealth.va.gov/media/american-indian-telemental-health.asx) is an overview of a series of clinics that use videoconferencing. More information on the telemental health clinics is available at www.ruralhealth.va.gov/native/programs/telemental-services.asp.

According to HHS, an estimated 87,000 fewer patients died of hospital-acquired conditions (HACs) between 2010 and 2014 thanks to national patient safety efforts.

The Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of adverse drug events, (ADEs) catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, surgical site infections, and other HACs and compared those with baseline data from 2010.

The HACs' numbers have steadily dropped 17% from 2010 to 2014, but the reasons  are not fully understood. Possible contributing causes include financial incentives created by Centers for Medicare & Medicaid Services and other payers’ policies, public reporting of hospital-level results, and technical assistance offered to hospitals.

The “major strides in patient safety are a result of strong, diverse public-private partnerships and active engagement by patients and families,” HHS says. One of those partnerships, the Partnership for Patients, was launched in 2011 to target specific HACs for reductions via systematic quality improvement. “Crucially,” the report notes, progress was made possible by AHRQ’s efforts in gathering evidence about how to make care safer, investments in tools and training to “catalyze improvement,” and investments in data and measures to track change.

Most of the improvements between 2010 and 2014 were seen in reducing ADEs, which accounted for 40% of the change: from 1,621,000 to 1,360,000 ADEs. (The AHRQ study looked at hypoglycemic agents, IV heparin, low-molecular weight heparin and Factor X an inhibitor, and warfarin.) The next largest category was pressure ulcers, which saw a 28% change. Interim data show an estimated 16,760 deaths due to ADEs were averted, as were 42,716 deaths due to pressure ulcers. “These new numbers are impressive and show the great progress hospitals continue to make,” said Rick Pollack, president and CEO of the American Hospital Association.        

As the improvements hold steady, their impact accumulates, AHRQ says. However, the AHRQ report points out, “There is still more work to be done.” The interim 2014 HAC rate of 121 HACs per 1,000 discharges is the same as it was in 2013 (some patients had more than 1 HAC). Moreover, in 2014, almost 10% of hospitalized patients experienced 1 or more of the HACs measured. “That rate is still too high,” the report panel concludes.

According to HHS, an estimated 87,000 fewer patients died of hospital-acquired conditions (HACs) between 2010 and 2014 thanks to national patient safety efforts.

The Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of adverse drug events, (ADEs) catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, surgical site infections, and other HACs and compared those with baseline data from 2010.

The HACs' numbers have steadily dropped 17% from 2010 to 2014, but the reasons  are not fully understood. Possible contributing causes include financial incentives created by Centers for Medicare & Medicaid Services and other payers’ policies, public reporting of hospital-level results, and technical assistance offered to hospitals.

The “major strides in patient safety are a result of strong, diverse public-private partnerships and active engagement by patients and families,” HHS says. One of those partnerships, the Partnership for Patients, was launched in 2011 to target specific HACs for reductions via systematic quality improvement. “Crucially,” the report notes, progress was made possible by AHRQ’s efforts in gathering evidence about how to make care safer, investments in tools and training to “catalyze improvement,” and investments in data and measures to track change.

Most of the improvements between 2010 and 2014 were seen in reducing ADEs, which accounted for 40% of the change: from 1,621,000 to 1,360,000 ADEs. (The AHRQ study looked at hypoglycemic agents, IV heparin, low-molecular weight heparin and Factor X an inhibitor, and warfarin.) The next largest category was pressure ulcers, which saw a 28% change. Interim data show an estimated 16,760 deaths due to ADEs were averted, as were 42,716 deaths due to pressure ulcers. “These new numbers are impressive and show the great progress hospitals continue to make,” said Rick Pollack, president and CEO of the American Hospital Association.        

As the improvements hold steady, their impact accumulates, AHRQ says. However, the AHRQ report points out, “There is still more work to be done.” The interim 2014 HAC rate of 121 HACs per 1,000 discharges is the same as it was in 2013 (some patients had more than 1 HAC). Moreover, in 2014, almost 10% of hospitalized patients experienced 1 or more of the HACs measured. “That rate is still too high,” the report panel concludes.

According to HHS, an estimated 87,000 fewer patients died of hospital-acquired conditions (HACs) between 2010 and 2014 thanks to national patient safety efforts.

The Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of adverse drug events, (ADEs) catheter-associated urinary tract infections, central line–associated bloodstream infections, pressure ulcers, surgical site infections, and other HACs and compared those with baseline data from 2010.

The HACs' numbers have steadily dropped 17% from 2010 to 2014, but the reasons  are not fully understood. Possible contributing causes include financial incentives created by Centers for Medicare & Medicaid Services and other payers’ policies, public reporting of hospital-level results, and technical assistance offered to hospitals.

The “major strides in patient safety are a result of strong, diverse public-private partnerships and active engagement by patients and families,” HHS says. One of those partnerships, the Partnership for Patients, was launched in 2011 to target specific HACs for reductions via systematic quality improvement. “Crucially,” the report notes, progress was made possible by AHRQ’s efforts in gathering evidence about how to make care safer, investments in tools and training to “catalyze improvement,” and investments in data and measures to track change.

Most of the improvements between 2010 and 2014 were seen in reducing ADEs, which accounted for 40% of the change: from 1,621,000 to 1,360,000 ADEs. (The AHRQ study looked at hypoglycemic agents, IV heparin, low-molecular weight heparin and Factor X an inhibitor, and warfarin.) The next largest category was pressure ulcers, which saw a 28% change. Interim data show an estimated 16,760 deaths due to ADEs were averted, as were 42,716 deaths due to pressure ulcers. “These new numbers are impressive and show the great progress hospitals continue to make,” said Rick Pollack, president and CEO of the American Hospital Association.        

As the improvements hold steady, their impact accumulates, AHRQ says. However, the AHRQ report points out, “There is still more work to be done.” The interim 2014 HAC rate of 121 HACs per 1,000 discharges is the same as it was in 2013 (some patients had more than 1 HAC). Moreover, in 2014, almost 10% of hospitalized patients experienced 1 or more of the HACs measured. “That rate is still too high,” the report panel concludes.