The Year in Veterans affairs & military medicine
photo by kelie burdette mendonca, public affairs specialist, sf vamc
■■ The Department of Veterans Affairs’ SCAN-ECHO teleconferencing program is being evaluated as a means of conducting consultations with diabetic patients.
Care Transformation, is the use of the agency’s teleconferencing program, SCAN-ECHO, to conduct consultations through a patient’s electronic medical record. The Cleveland VAMC is one of the centers simultaneously rolling out and studying the diabetes SCAN-ECHO, said Aron. “This is an example of research and operations informing each other,” he said. “Research can be adjusted to meet the operations needs, and operations can be adjusted based on the research findings. This kind of partnered research has become of great interest to VA HSR&D.” When research and interprofessional clinical care are conducted alongside each other, informing real-time adjustments, the knowledge base evolves rapidly. In some settings, said Aron, clinical practice is slow to catch up. “I think one of the most critical research questions, in medical practice in general and in diabetes specifically, is: How do you stop doing what was previously accepted as correct, when it is shown no longer to be correct?” For example, the clinical care guidelines developed by the VA and other organizations have, for more than 15 years, emphasized the importance of establishing individualized targets for glycemic control – and yet research led by Aron and Pogach has revealed many practitioners continuing to
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work with a fixed target, in the common A1c blood test, of less than 7 percent glycated hemoglobin. This target isn’t appropriate for many patients, such as those at risk for low blood sugar. “[Seven percent] has been the mantra for many years,” Aron said, “but for many patients, that degree of glycemic control is not appropriate. It will provide little, if any, benefit, but comes with risks.” Based on the findings of Aron, Pogach, and others, the VA and the Department of Health and Human Services (HHS) will soon roll out a nationwide Hypoglycemia Safety Initiative to encourage individualized targets for glycemic control. Aron has been funded to evaluate the efficacy of the initiative. “There will be a number of research questions coming out of that,” he said. “Specifically, how do you get people to de-implement outdated practices?” In terms of the number of patients who have a stake in such questions, there may be no more important research program at the VA than the portfolio of studies designed to attack diabetes, prevent it from occurring, and optimize the care delivered to diabetic veterans. VA investigators and clinicians are helping lead the way in learning which interventions will optimize outcomes for these patients – and, if necessary, in unlearning those that won’t. n 45