In a recent multi-center study comparing diabetes care between VA and non-VA sites, it was determined that care was better managed within VA. This analysis in a National Institutes of Health (NIH)-funded diabetes comparative effectiveness research study was led by Ralph H. Johnson VA endocrinologist and researcher Dr. Hermes Florez.
“Through this study, we’ve found that despite the increased complexity of our VA patients when compared to patients seen in the community, our Veterans receive better diabetes care,” Florez said. “I can personally attest to the high-quality care in the inpatient and outpatient setting since I began working for VA in 1998 and as a physician at the Charleston VA for the last two years.”
Florez says there are six key factors that contribute to this high quality of diabetes care for Veterans both nationwide and at Charleston VA.
First, the Ralph H. Johnson VA Medical Center’s diabetes program has a dedicated nurse navigator. This nurse is part of the interdisciplinary team that manages patients with diabetes. The nurse navigator is integral to the continuity of care Veterans receive and assists by coordinating appointments, completing timely evaluations of diabetes post-discharge, scheduling testing and tracking care.
Second, the organized interdisciplinary team is specially trained in diabetes education.
“The team empowers patients with proper knowledge to make good decisions and have good glucose control,” Florez added.
Third, VA has a unique ability to get information from clinical trials and translate that to bedside and outpatient care quickly. Florez notes there are seamless transitions to clinical care without risky adverse events.
Fourth, there is a wealth of knowledge in VA’s electronic health record (EHR) as VA was one of the first health care systems to roll out an EHR decades ago.
“If a patient had pre-diabetes 10 years ago, we could use the information in the EHR to pinpoint when they developed diabetes and create an individualized treatment plan based on that history and baseline data of that patient,” Florez said.
Fifth, because VA has a long history of treating diabetes as a system, there is a tremendous amount of clinical information within VA related to tailoring treatments for patients. The care team can adjust the patient’s treatment plan based on the Veteran’s degree of functionality, age and other important factors.
Finally, Veterans enrolled in VA care tend to stay within the VA system for years, allowing them to get better diabetes care management over time.
Tackle diabetes before it develops
“It’s a great advantage that, as Veterans relocate, they have options for VA care throughout the country that allows them to stay within our system. We have lots of medical information on that patient for many, many years,” Florez said.
As Florez and VA look toward the future management of diabetes, they are reviewing what interventions help Veterans in that pre-diabetes phase to best preserve the Veteran’s quality of life.
“With a large prevalence of obesity among Veterans, we want to be able to tackle diabetes before it develops and the patient’s health declines,” he added.
The Million Veteran Program, a national research program to learn how genes, lifestyle and military exposures affect health and illness, is also giving VA a tremendous amount of data to manage diseases like diabetes.
Florez also credits a strong and unique academic affiliation with the Medical University of South Carolina (MUSC) as part of Ralph H. Johnson VA’s ability to conduct research in a collaborative way that benefits both Veterans and the general population.
Florez additionally serves at MUSC as chair of the Department of Public Health and the Associate Dean of Population Health.
“With a greater diversity of patients in the community, the platform of collaboration helps better reach minority groups that are expanding in South Carolina,” he said. “Bridging this gap in turn may reduce health disparities.”