Enterprise-Wide Initiative (EWI) - Specialty Care
National Cardiology Hub and Spoke Network
Background
Cardiovascular disease is the leading reason for hospitalization of Veterans and is also one of the leading indications for referral to community care in the Department of Veterans Affairs (VA) Veterans Health Administration (VHA). Procedural outcomes, including mortality for elective percutaneous coronary interventions, are superior for Veterans who receive care within the VHA compared to the same services provided in the community. Despite better or comparable outcomes for care provided to Veterans within VHA, cardiac procedural volumes within VHA programs are rapidly declining, and most invasive cardiac procedures done on Veterans are now done in the community.
Goals and Objectives
The goal of the VHA Office of Rural Health (ORH) Cardiology Hub and Spoke Network Enterprise-Wide Initiative (EWI) is to expand procedural healthcare access for rural Veterans with cardiovascular disease. This program aims to leverage the outstanding cardiology services provided at large, high-complexity VA medical centers (VAMCs) and hubs to bring Veterans requiring high-complexity procedural and other face-to-face care to those VAMCs. The program also extends cardiology care to smaller VAMCs, referred to as spokes, and community-based outpatient clinics (CBOCs), referred to as sub-spokes, for pre-and post-procedural visits and other care that can be delivered virtually and/or by Advanced Practice Providers (APPs) under the supervision of Cardiologists at their hub site. Cardiovascular care in the network is geared towards treating the most common cardiovascular conditions facing Veterans: ischemic heart disease, atrial fibrillation/atrial flutter, aortic stenosis and congestive heart failure.
To facilitate this care coordination, the National Cardiology Program is building the team and infrastructure to establish a Cardiology Hub and Spoke Network to bring Veterans to facilities (hubs) for cardiovascular procedures. The Cardiology Hub and Spoke Network is designed to improve VHA cardiology systems of care, so Veterans have improved access to VHA care and community care costs for these invasive procedures is reduced. This approach can lead to improved health outcomes by coordinating care, services, and communications to align care and services.
Goals
- Expand Access to High-Quality Cardiology Care for Rural Veterans
- Enhance Care Coordination and Continuity
- Improve Patient Outcomes
- Optimize Resource Utilization
- Promote Patient-Centered Care
Objectives
- Infrastructure Development
- Provider Training and Engagement
- Increase Procedure Referrals
- Use of Technology for Care Delivery
- Quality Monitoring and Improvement
- Patient Engagement and Education
- Cost-Effectiveness Analysis
By pursuing these goals and objectives, the Cardiology Hub and Spoke Network aims to create a robust and effective cardiology care delivery model that ultimately meets the needs of rural Veterans while enhancing the overall effectiveness of VHA services.
Methodology
The methodology for implementing the Cardiology Hub and Spoke Network adopts a structured approach to enhance effective planning, execution, monitoring, and evaluation. It begins with a thorough needs assessment to identify specific requirements, followed by infrastructure development to establish the necessary framework. Training and education are prioritized to equip the team with essential skills, paving the way for effective implementation of the network. Care coordination ensures seamless connections between different care levels, while ongoing monitoring and evaluation ascertain the network's efficacy. Finally, strategies for scaling and sustainability are incorporated to secure long-term success, and comprehensive reporting and dissemination efforts promote transparency and knowledge sharing throughout the process. By following this structured methodology, the Cardiology Hub and Spoke Network will effectively enhance access to specialized cardiology care for rural Veterans while ensuring high-quality, coordinated care that addresses their unique health care needs.
The Cardiology Hub and Spoke Network is currently being implemented in Veterans Integrated Service Networks (VISNs) 10 and 15; hub facilities are the Lieutenant Colonel Charles S. Kettles VA Medical Center (VAMC) in Ann Arbor, Michigan and the Harry S. Truman Memorial Veterans Hospital in Columbia, Missouri, in VISNs 10 and 15, respectively. Spoke sites for each location include the Aleda E. Lutz VAMC in Saginaw, MI, the Battle Creek VAMC in Battle Creek, Michigan (in VISN 10) as well as the VA Eastern Kansas VAMC in Topeka, Kansas and the John J. Pershing VAMC in Poplar Bluff, Kansas (in VISN 15). While the Cardiology hub and spoke network has experienced delays in implementation related to hiring and onboarding of staff as well as delays in equipment purchases, patients are currently being seen throughout the Battle Creek, Michigan spoke and sub-spoke sites, and are being referred to the Ann Arbor VAMC as appropriate for procedural care. Hiring of clinical personnel is underway in VISN 15, which was delayed in implementing the Network because it was selected after VISN 19, the originally proposed second site, was unable to hire staff due to VISN-wide hiring challenges.
The Cardiology Hub and Spoke Initiative also includes an evaluation component with both qualitative and quantitative components being performed by the VA Collaborative Evaluation Center (VACE). They have performed interviews with Veterans as well as providers as part of the pre-implementation baseline data and are now beginning the post-implementation data collection phase.
Impact on Rural Veteran Health
The implementation of the Cardiology Hub and Spoke Network will have significant and positive impacts on rural health, particularly for Veterans suffering from cardiovascular diseases.
Potential impacts for rural Veterans include:
- Increased Access to Care
- Enhanced Care Coordination
- Improved Health Outcomes
- Increased Patient Satisfaction
- Reduced Health Care Costs
- Workforce Empowerment and Development
- Long-term Health Promotion
- Strengthened Community Health Systems
Overall, the Cardiology Hub and Spoke Network has the potential to substantially improve the health and healthcare experience of rural Veterans with cardiovascular disease. This program provides a sustainable model to overcome geographic and other barriers to cardiology care. The Cardiology Hub and Spoke Network will increase rural Veterans access to quality VHA health care services and support better health outcomes.
Key Takeaways
- Enhanced Access: The Hub and Spoke Network significantly improves access to specialized cardiology care for rural Veterans, reducing barriers related to distance and travel.
- Improved Health Outcomes: Timely interventions and consistent management of cardiovascular diseases through this network can lead to better health outcomes, including lower rates of complications and hospitalizations.
- Coordinated Care: Integration of care teams and streamlined communication among healthcare providers fosters a holistic approach to patient management, ensuring that all aspects of a Veteran's health are addressed.
- Cost-Effectiveness: By minimizing unnecessary travel and hospitalizations, the network can lower healthcare costs for Veterans and the VHA, making care more affordable and efficient.
- Patient Engagement: Increased accessibility to care and educational resources empowers Veterans to take an active role in managing their health, leading to higher patient satisfaction and involvement in their care plans.
- Workforce Development: Training and supporting local healthcare providers strengthen the rural healthcare workforce, enhancing their ability to deliver high-quality care within the network.
- Focused Preventive Care: The network supports preventive care initiatives that promote cardiovascular health, addressing risk factors and encouraging healthier lifestyles within rural communities.
- Long-term Sustainability: The establishment of robust data collection and performance metrics allows for ongoing assessment and continuous improvement of the network, promoting its longevity and effectiveness.
- Data-Driven Insights: The network will generate valuable data on cardiovascular health trends among rural Veterans, informing future health policy and targeted interventions.
The Cardiology Hub and Spoke Network presents a transformative approach to addressing the unique healthcare needs of rural Veterans with cardiovascular conditions. By improving access, coordination, and patient engagement, the network will enhance health outcomes and quality of care while promoting sustainability and growth within rural healthcare systems.
Download the Printable PDF for Healthcare Providers and Researchers.
Contact
- Sara Ann Todd, DHA, National Program Manager, National Cardiology Hub and Spoke Network Program. VA Ann Arbor Healthcare., Ann Arbor, MI. Sara.Todd@va.gov
- Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00581.
- Suggested Citation: Todd, S.A. (2024). National Cardiology Hub and Spoke Network. Department of Veterans Affairs, Veterans Health Administration. Washington, DC. Office of Rural Health. Retrieved from https://www.ruralhealth.va.gov/enterprise-wide-initiatives/national-cardiology-hub-spoke-network.asp.
Rural Health - Navigation
- Office of Rural Health Home page: https://www.ruralhealth.va.gov/index.asp
- Enterprise-Wide Initiative (EWI) Home page: https://www.ruralhealth.va.gov/providers/Enterprise_Wide_Initiatives.asp
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