Clinical Public Health

Clinical Public Health plays an integral role in improving the health of targeted populations. We identify and address potential barriers to evidence-based care, develop best-practice models and collaborate to integrate practice models into care across the VA system. We use surveillance, research, education, policy development and implementation strategies to optimize health outcomes.

Clinical Public Health is divided into four subprograms:

1. Tobacco and Health Policy Programs is responsible for the development and oversight of national health policy and clinical programs relating to smoking and tobacco-use cessation and tobacco-control issues, such as the prevention of exposure to second-hand smoke.
2. The National HIV, Hepatitis C and Public Health Pathogens Programs provide guidance and policy for HIV and chronic hepatitis C care in VA, including clinician and patient education, prevention activities and quality improvement initiatives dedicated to delivering high-quality care to veterans with HIV/AIDS, hepatitis C or both. We are the nation’s largest provider of care for HIV and HCV, with over 90% of HIV-positive veterans receiving treatment.
3. Infection: Don’t Pass It On is an ongoing public-health campaign to engage and educate veterans, their families, VA staff and visitors to VA healthcare facilities to prevent the transmission of influenza and other communicable infectious diseases.
4. Public Health Surveillance and Research conducts surveillance and research on influenza, healthcare-associated infections and antimicrobial use, in addition to surveillance to support public-health emergency preparedness and epidemiologic investigations within VHA.

Employee wellness (VA Photo)

Important recent accomplishments from Clinical Public Health include serving as one of six federal agencies responsible for implementing the White House National HIV/AIDS Strategy and leading the effort to implement VA’s policy to test all veterans for HIV; serving as part of the HHS Hepatitis Interagency Working Group to improve hepatitis prevention, diagnosis and care in the U.S.; providing policy and program leadership in response to new hepatitis C treatment options; increasing access to evidence-based tobacco cessation care across VHA; leading national initiatives to integrate smoking-cessation care into PTSD and substance-use disorder care; producing an annual influenza prevention tool kit; collecting surveillance data on influenza illness and vaccination; managing the distribution of more than 1.5 million doses of H1N1 vaccine to VA facilities in collaboration with the CDC; developing the Healthcare Acquired Infection and Influenza Surveillance System (HAIISS) that tracks infections throughout the VA system from the electronic health record; and conducting public health investigations within VA.

Occupational Health

Over its 10 years of existence Occupational Health has supported, furthered, developed or created a broad range of activities that have made it a leading healthcare occupational health program in the United States. Occupational Health consists of three primary subprograms:

1. Hazard Mitigation and Infrastructure Support addresses occupational health epidemiology and safety programs.
2. Clinical Programs include clinical occupational health, workers’ compensation and employee health promotion.
3. Center for Occupational Health and Infection Control bridges the gap between research and practice by addressing health and safety issues at local and national levels.

Within VA, Occupational Health programs have:

• Increased the timely filing of workers compensation claims from 45% to over 95%
• Led the implementation of a four-year $200 million VA-wide Safe Patient Handling program, with a 40% decline in manual handling injuries among VHA nurses
• Trained front-line workers in violence prevention
• Implemented a threat assessment and management program
• Developed a protocol for mold assessment and removal in VHA facilities

We also designed and launched VA’s first electronic Occupational Health Record-Keeping System — recently identified by the Government Accountability Office as a Federal-wide best practice in IT acquisition. We led the creation of a national Employee Health Promotion Program — Wellness is Now (WIN) — a program intended to create a culture of wellness among employees that improves health, reduces preventable injuries and illness, and encourages employees to inspire veterans to live healthier lifestyles. At pilot sites, the WIN program reduced absenteeism and health insurance costs and increased worker productivity. The program has been so successful that Occupational Health was invited to serve as a consultant to the Office of Personnel Management as they design employee wellness programs for all federal agencies.

Population Health

In September 2011, VHA approved the creation of a Population Health group within the Office of Public Health. The program involves assessment, development and implementation of tools for front-line staff and leadership to assist with optimizing the care of individuals in specific groups. Initial priorities for Population Health include focus on care for veterans in rural areas, veterans with mental-health conditions and preventive healthcare for all veterans.

Population Health includes an existing national program, the Center for Quality Management (CQM), which uses quality performance and clinical information systems to promote high-quality, safe, effective and efficient healthcare for veterans with conditions of public health significance. Population-based software tools developed by CQM to monitor care for veterans with hepatitis C and HIV have been associated with high performance on National Quality Forum performance measures for HIV/AIDS care.

Upcoming Population Health efforts will inform future veteran care by examining how care has changed over the past decade with respect to geographic location, demographics, entitlements and benefits, social factors, access to care and services, presence of co-morbidities, period of service and war-related injuries and exposures. Work is under way on a project looking at characteristics and health needs among rural vs. urban veterans. This information will assist VA clinicians, administrators and leadership in improving future VA care and the overall health of our veterans.

Backus LI, Boothroyd DB, Phillips BR, Belperio PS, Halloran JP, Valdiserri RO and Mole LA. National Quality Forum Performance Measures for HIV/AIDS Care. Arch Intern Med. 2010:170(14);1239-46.

Conclusion

We are proud to serve veterans as the VA’s authority on public health. We are committed to the continued maintenance of a cohesive and robust system to assess, define and respond to the public-health needs of veterans, their families, staff and the broader VA community. We are the public health department for the Department of Veterans Affairs.

[1]Backus LI, Boothroyd DB, Phillips BR, Belperio PS, Halloran JP, Valdiserri RO and Mole LA.  National Quality Forum Performance Measures for HIV/AIDS Care. Arch Intern Med. 2010:170(14);1239-46.

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