Enterprise-Wide Initiatives

The Office of Rural Health (ORH) implements programs that deliver increased care and support to rural Veterans nationwide in a more uniform manner. ORH’s programs are in two categories: Rural Promising Practices and Enterprise-Wide Initiatives (EWIs). EWIs expand national U.S. Department of Veterans Affairs' (VA) program offices’ health care efforts to sites that serve rural Veterans. Initial funding support is available by ORH to support implementation in VA facilities across the country. EWI programs include:

The ORH Center for the Evaluation of Enterprise-Wide Initiatives systematically reviews EWIs to improve evaluation and comprehensively analyze impact while contributing to the field of implementation science.

Primary Care

• Home Based Primary Care expands home-based Patient Aligned Care Team services to rural areas.
• Medical Foster Homes provide an alternative to nursing homes for Veterans who need daily assistance, are unable to live independently, and have no available family caregiver.
• Supporting Community Outpatient, Urgent Care & Telehealth Services (SCOUTS) is a post-emergency department complementary service that utilizes intermediate care technicians to support care transitions. This ensures that unmet care needs, geriatric syndromes, and digital divide concerns are addressed in an acute time frame.

Specialty Care

• Centralized Anticoagulation Services Hub (CASH) provides anticoagulation clinical pharmacy services via highly efficient infrastructure that standardizes clinical processes, employs innovative data tools, and delivers virtual care modalities.
• Clinical Pharmacy Specialist Providers deliver medication and chronic disease management services to rural Veterans through telehealth in Veterans' homes, VA medical centers, or community based outpatient clinics.
• Gerofit utilizes telehealth to connect rural Veterans over the age of 65 with exercise programming. The health and wellness program strives to improve participants’ balance, endurance, and strength while building a sense of community. Participants have demonstrated improved health, mental and physical function, and overall well-being.
• Improving Rural Veterans' Access to Rheumatology Care Nationwide provides access to rheumatology care for Veterans living in rural areas with systemic autoimmune diseases and other complex rheumatic conditions.
• Increasing Access for Rural Veterans by Leveraging Clinical Pharmacist Providers (CPPs) to Deliver Chronic Obstructive Pulmonary Disease (COPD) Care utilizes CPPs to increase patient access, improve quality of care, and decrease provider burden through the delivery of comprehensive medication management and COPD care for rural Veterans within primary care teams.
• Mobile Prosthetic and Orthotic Care (MoPOC) helps to restore function, mobility, and independence for rural Veterans with limb loss and movement disorders by bringing artificial limb and bracing care to their communities.
• National Cardiology Hub and Spoke Network provides rural Veterans streamlined access to invasive cardiovascular procedure care in high-complexity VA medical centers (hubs) through intitial access to VA cardiology services closer to home, nurse navigation, and travel support to and from hub facilities.
• The National Telecritical Care (TCC) Program connects VA facilities that do not have intensivists on staff with VA intensivists nationwide via telehealth to increase access to TCC services and specialty inpatient care for rural Veterans.
• The National Tele-Hospital Medicine Program is a hub and spoke telehealth program that provides access to hospital medicine services and expertise for rural and under-provided VA medical centers with acute care needs that cannot be met by the local workforce.
• The National Telenephrology Hub and Spoke Network works with local providers to offer specialty nephrology services to Veterans in rural areas with kidney disease or difficult-to-control hypertension.
• The National Teleneurology Program establishes telehealth sites to ensure access to neurology in rural areas where providers are unavailable.
• Pharmacist Providers Improve Access for Rural Veterans with Opioid Use Disorder delivers greater access to medication assisted treatment for rural Veterans by integrating clinical pharmacy specialist providers in collaborative care models.
• Sleep Telemedicine supports diagnosis, care, and remote monitoring of Veterans with sleep apnea via web-enabled devices.
• Technology-Based Eye Care Services is a telehealth-based eye screening initiative that places ophthalmology technicians in rural VA clinics to collect information about a patient’s eyes and transmit it to VA ophthalmologists for diagnosis and follow-up.
• Teleaudiology provides remote audiology fittings and aftercare services, remote diagnostic testing, and audiometric testing for rural Veterans.
• Teledermatology expands store-and-forward teledermatology to rural sites; it includes primary care training on dermatologic consults and minor procedures.
• Telerehabilitation Services expand an integrated network of specialists, who are specifically trained in delivering physical and rehabilitative therapy, to rural Veterans using telehealth technology.

Mental Health

• Advance Care Planning via Group Visits connects Veterans to advanced care planning experts who help them develop a plan to address how health care decisions will be made if they are unable to communicate.
• Rural Access Network for Growth Enhancement provides intensive case management services, including homelessness outreach, to seriously mentally ill Veterans in rural areas.
• Rural Suicide Prevention connects Veterans to comprehensive suicide prevention services and resources through enhanced education, public awareness campaigns, community training, crisis support, firearm safety, and care management for high-risk individuals.
• Social Work in Patient Aligned Care Teams expands the integration of rural social workers into the Patient Aligned Care Team model to improve care coordination for rural Veterans and their interdisciplinary care teams.

Workforce Training and Education

• The Acute Inpatient Medicine - High Reliability, Learning Environment and Workforce Development Initiative (AIM-HI) allows rural hospitals to enhance learning, teamwork, and reliability for rural health care teams.
• Clinical Skills Training in Women Veterans Health Care trains providers in rural locations in skills unique to the treatment of rural women Veterans.
• Maximizing Ongoing Development and Educational Leadership (MODEL) for VHA Hospitalists is an interactive faculty development series tailored to the unique needs of VA hospital medicine providers. It utilizes a facilitation-based format to promote collaboration among participants.
• National Mental Health (MH) and Suicide Prevention (SP) Extension for Community Healthcare Outcomes (ECHO) connects rural providers to national MH and SP specialists for regular discussion of clinical cases and targeted skill-building training on suicide prevention and substance use disorder treatment.
• Rural Interprofessional Faculty Development Initiative (RIFDI) provides training for residency proctors, enabling them to better train, mentor, and monitor residents serving rural areas.
• VA-ECHO Expansion in Specialty Care provides live/virtual, case-based learning to a wide variety of clinical team members in over 20 medical specialty areas, including nephrology, pain management, pulmonology, diabetes/endocrinology, and the coronavirus.
• Virtual Care Integration seeks to instruct and coach primary care staff in population health outreach and chronic disease management aligned with virtual technologies, tools, and other innovative designs to reach the most rural Veterans.

Clinical Resource Hubs

• Clinical Resource Hubs are Veterans Integrated Service Network sites that provide primary, mental health, medical specialty, and rehabilitation and extended care, as well as surgery services, to Veterans in underserved areas.

VA Video Connect

• The VA Video Connect Patient Tablet Program provides rural Veterans with video telehealth tablets to connect patients with and transmit patient data to a remote VA health care provider through a secure internet connection.

Innovation

• Rural Innovation Ecosystem supports new service delivery innovations and the national implementation of standardized best practices intended to improve access to care and services for rural Veterans.

Transportation

• The Highly Rural Transportation Grants Program (HRTGP) expands transportation access for healthcare services to Veterans living in highly rural areas. 
• Veteran Transportation Services provides medical transportation services for rural Veterans and includes leases of vehicles, salaries for drivers, and mobility managers.