More than two million Americans have served in the US military in Iraq and Afghanistan since October, 2001, the month after 9/11. The government has the duty to take care of its heroes once they return home, thus the Department of Veteran Affairs, or the VA, was born. Part of this responsibility falls into the realm of healthcare, where the Veterans Health Administration (VHA), the largest integrated health care system in the country, takes charge. Though one might suspect that the majority of care provided to veterans through the VHA is related to injuries sustained during combat, veterans also suffer from the burden of common, preventable chronic diseases at a higher rate than non-veterans.
In order to combat chronic disease, the VHA must develop strategies and allocate resources to prevention, which is a challenge since veterans return from service with other injuries and possibly developing or developed chronic illnesses. Prevention is difficult when it comes to veterans because the military does not screen enlisting soldiers for chronic disease, and veterans often return home with additional disabilities that complicate their care and often become their primary concern. As a result, the VHA has taken creative steps to ensure Vets receive the best possible preventive care.
In ensuring Vets are healthy and/or helping them become healthy, the VHA must work to prevent the manifestation of chronic diseases, while simultaneously treating other serious illnesses or disabilities that result from combat. In conjunction with its strategic plan, the VHA’s approach to preventive care for combat veterans is based on the standard model of population health management. In this model, there are three categorizations of prevention: primary, secondary, and tertiary. Primary prevention is when the Vet has no disease and no impairment, so the focus is wholly on prevention. Secondary prevention is when an impairment or disease has been detected; here, the prevention is targeted and aggressive. Tertiary prevention is done in conjunction with treatment for a diagnosed disease or impairment. Categorization is incredibly important for VHA efficiency and for patient centered care, allowing the patient to receive the best and most effective treatment and regimen for prevention.
Patient centered care is important to preventive care efforts because cases at the VHA are increasingly diverse due to the complex nature of combat-related disability (both physical and mental), and the diverse demographic that the VHA serves. In response to these needs and patient diversity, the VHA strives to “empower vets to improve their well-being” by using a recently released proactive health and wellbeing model. Through this integrative model developed by the Office of Patient Centered Care and Cultural Transformation, the VA is working to explore personalized, proactive, and patient-centered medicine. In addition, another program generated from within the VA that focuses on prevention is project MOVE!, a popular weight management health promotion program.
The VHA, in conjunction with partners, is working to implement personalized, proactive medicine and manage the increasingly diverse medical needs of Vets. The VHA’s refocus of its strategy to a patient centered approach is a much needed step towards managing and providing for patients as the department works to undergo an overhaul.
Rosie Wood is an intern for the Duke Center for Research on Personalized Health Care and a senior attending the University of North Carolina at Chapel Hill