The Department of Veterans Affairs Veterans Health Administration Office of Rural Health (ORH) has established an Emergency Medicine Analytics Team (EMAT) as part of its ongoing effort to improve health care for rural veterans.
The initiative, set to launch in fiscal year 2025, will be co-directed by Michael Ward, MD, PhD, MBA, vice chair and associate professor of Emergency Medicine and Biomedical Informatics at Vanderbilt University Medical Center, representing the VA Tennessee Valley Healthcare System in Nashville, and Anita Vashi, MD, MPH, from the Center for Innovation to Implementation at the Palo Alto VA Medical Center in California.
“More than 80% of rural veterans don’t have access to a VA emergency department or VA urgent care,” Ward said. “As a result, they go to non-VA emergency care settings that don’t have the integrated electronic record like the VA does. The VA is spending over $500 million a month on non-VA emergency care. You can see why costs would skyrocket in that particular setting.”
EMAT’s initial activities will concentrate on two primary domains:
- Access to acute services, including evaluations of virtual programs and community care utilization
- Quality of emergency care, with a focus on evidence-based risk stratification and prescribing quality for common conditions
As the program evolves, it will focus on three strategic priorities:
- Evaluation, including assessments of quality, safety, utilization, cost and patient experience
- Innovation development, focusing on new tools, processes and pilot interventions
- Dissemination of effective practices, interventions, programs and policies
“We’ve worked with the Tennessee Valley VA and have done research in VA emergency care for years now with a particular emphasis on disparities for veterans who live in rural settings,” Ward said. “In one particular area, studying transfers among rural veterans with emergency conditions, we found a serious care gap among those with mental health problems. That led to us developing a telehealth intervention that we implemented in 2019, and it really took off during the pandemic.”
Along with separate work done by Ward and Michael Matheny, MD, MS, MPH, professor of Biomedical Informatics, examining influencing clinical behavior around prescribing, they built and implemented an electronic surveillance tool in the VA to examine prescribing quality in the emergency care setting.
This body of work contributed to ORH reaching out to Ward and Vashi asking them to create EMAT. A similar program was recently created by the VA for hospital medicine.
“There was a real gap in rural veterans’ emergency care, and this is a significant step toward addressing it,” Ward said.
This initiative aligns with the Office of Rural Health’s mission to improve the health and well-being of rural veterans and the VA’s priority of becoming a learning health care system.
“By focusing on acute medicine, we hope to eventually enhance the quality and accessibility of emergency care for veterans nationally,” Ward said. “With any sort of complex program, you have to understand it, and understand where you can intervene and have a mechanism by which you can intervene. Spending $500 million a month isn’t just going to get magically fixed, and when you don’t have the physical infrastructure to tell patients to just go to the nearest VA when there isn’t one, you can’t easily fix the problem.”
