Parkinson’s: A Network of Care within the Veterans Healthcare System

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By Robert L. Ruff, MD, PhD, and Patricia G. Banks, RN, MSNEd, CCRP

Louis Stokes Cleveland Veteran Affairs Medical Center

BACKGROUND

In 2001, the VA began the process of enhancing services for the approximately 40,000 veterans afflicted with Parkinson’s disease, initiating a plan for setting up six Parkinson’s and Associated Disorders Research, Education and Clinical Centers (PADRECC). The centers would be established in conjunction with a VA Cooperative Studies Research Program (CSP) that evaluated deep-brain stimulation (DBS) in veterans with PD (CSP 468). CSP 468 was carried out in conjunction with a multicenter trial of DBS in nonveterans with PD funded by the National Institutes of Neurological Diseases and Stroke Institute (NINDS) of the National Institutes of Health.

Each PADRECC Center would be identified through a competitive peer-review process that assessed: strength in PD veteran care, strength in clinical and laboratory research programs related to PD and affiliation with an accredited university that has strength in PD care and research. These centers would connect subject matter experts having high levels of expertise in Parkinson’s and would function as regional centers for performing very complex procedures, such as DBS, and for referral of complicated veterans. The centers also would distribute knowledge and support a broad network of PD providers throughout VHA.

Actions Completed

In 2001, six Centers of Excellence were founded at the Philadelphia, Richmond, Houston, West Los Angeles, San Francisco and Portland/Seattle VA Medical Centers. Each PADRECC is designed to deliver state-of-the-art clinical care, pioneering research and educational programs to an expansive geographic region. These centers are staffed by internationally recognized movement-disorder specialists and researchers. In 2003, the PADRECCs introduced the National VA Parkinson’s Disease Consortium in an effort to promote PD awareness across the VA Healthcare System.

Present Status

The Allocation Resource Center (ARC) identified 30,529 unique veterans with PD who obtained care from the Veterans Health Administration (VHA) during fiscal year 2009. Presently, VA medical centers treat at least 40,000 PD patients every year. The Consortium Center Network was subsequently launched as a means to broaden the impact of the PADRECC mission. These more than 50 designated centers grant veterans convenient access to specialized movement-disorders services within all Veterans Integrated Service Networks (VISN). These veterans typically have significant levels of disability and require high levels of service. Thus, the consortium sites in each VISN support primary caregivers at both inpatient and outpatient facilities, and pharmacy service works with the PADRECCs to ensure that appropriate medications are available to all veterans cared for within VHA. This service is provided with the realization that a key factor for supplying a medication is that the medication is effective, not how much it costs.

Similarly, the prosthetics service provides veterans with PD durable medical equipment, such as an assistive device for walking, feeding or dressing that is prescribed by a physician. Each center has pursued an area of expertise that has shaped the collective PADRECC model. As examples, the San Francisco PADRECC serves as the leading authority on deep-brain stimulation (DBS), while the Philadelphia PADRECC has produced groundbreaking findings on the neuropsychiatric aspects of PD. At conception, the West Los Angeles PADRECC (WLA) took a unique approach with the establishment of a capsulated PADRECC network in the southwestern region of the healthcare system. This initiative has focused on professional networking, mentorship and training.

The PADRECCs and Consortium Centers now create a hub-and-spokes model of care that is highly innovative and effective and composed of more than 225 members. Membership includes physicians, nurses, pharmacists, social workers, physical and occupational therapists and other allied-health professionals. Membership is free and encouraged for all VA providers.

For the Future

VA is a total care health system and during the past 10 years has made great progresses in treating PD. Looking toward the future, VA’s goals include continuing the development of resources to provide premier healthcare to our nation’s veterans with PD. Strategies to ensure the VA mission is met include:

• strengthening community outreach collaboration,

• incorporating the use of survey instruments for collecting vital feedback from patients/families to improve care and services,

• expanding collaborative projects on cognitive impairment in Parkinson’s disease,

• expanding the utilization of telehealth in the care of Parkinson’s patients, and

• promoting the translation of basic science findings to clinical trials.

The last will be strengthened through a collaborative use of VA resources and National Institute of Neurological Disorders and Stroke (NINDS) support for the Oregon Health and Sciences University (OHSU) Center of Excellence for clinical trials in neuroscience in Portland.

VHA faces a challenge to make the most use of expertise that exists among its caregivers and the resources in VA Medical Centers and through the affiliations that VA Medical Centers have with universities. The PADRECC consortium provides a way to connect the resources that exist within VHA to treat Parkinson’s disease with all of the VHA care sites. Through the PADRECC Consortium, VA can offer excellent quality medical care, access to centers for deep-brain stimulation and other cutting-edge technology and strong interaction with research, so that care is kept at a high level.

REFERENCES

Dorsey ER, Constantinescu R, Thompson JP, et al. Projected number of people with Parkinson’s disease in the most populous nations, 2005 through 2030. Neurology.2007;68(5):384-386.

Weintraub D, Comella CL, Horn S. Parkinson’s disease-part 1: pathophysiology, symptoms, burden, diagnosis and assessment. American Journal of Managed Care. 2008;14(Suppl 2):S40-48.

Department of Veterans Affairs. Disease associated with exposure to certain herbicide agents (hairy cell leukemia and other chronic b-cell leukemias, Parkinson’s disease, ischemic heart disease). Federal Register. 2010; 75;53202-53216. http:/federalregister.gov/a/2010-21556. Accessed Nov. 7, 2012.

Department of Veterans Affairs. National VA PD Consortium Network Referral List. www.parkinsons.va.gov/Consortium/nationalvapdconsortiumnetworkandreferrallist.asp. Accessed Nov. 7, 2012.

Department of Veterans Affairs. National VA PD Consortium Network. www.parkinsons.va.gov/Consortium/index.asp. Accessed Nov. 7, 2012.

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