QUERI – Quality Enhancement Research Initiative

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QUERI E-news
November 2019

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Improving Prosthetic Care for Veterans with Major Limb Loss

VA provides care for more than 50,000 Veterans with major limb loss, including those with amputations secondary to combat.

VA provides care for more than 50,000 Veterans with major limb loss, including those with amputations secondary to combat. Across the VA healthcare system, the prosthetic limb care process is labor and time intensive, inconsistent across facilities, and difficult to coordinate between frontline staff (e.g., clinical, administrative, logistics and acquisition). To address these challenges, clinicians with the FLOW3: Diffusion of Excellence Gold Status Practice – Enterprise-Wide Diffusion have developed a computerized management system to optimize the prosthetic limb process by improving:

FLOW3 was chosen through the Diffusion of Excellence (DoE) Initiative’s Shark Tank Competition. Since 2015, VA staff have submitted more than 1,676 practices, 47 of which have been chosen as high-impact, Gold Status practices (Vega et al, 2019).”

  • Timeliness in providing prosthetic limbs to Veterans,
  • Data systems that manage and report on prosthetic limb provision,
  • Employee satisfaction, and
  • Veteran customer experience.

FLOW3 is a novel workflow computerized management system that incorporates three custom-designed applications to facilitate the process for obtaining prosthetic limbs for Veterans – from prescription, specification, procurement, and fabrication to delivery and verification. The FLOW3 system makes the prosthetic limb process more predictable and consistent, creating a high-quality experience for Veterans and staff. As a result, FLOW3 was identified by QUERI, Rehabilitation and Prosthetics Services (RPS) and the Diffusion of Excellence (DoE) as one of the practices that will be funded to facilitate further implementation and expansion to other Veterans Integrated Service Networks (VISNs) and at Regional Amputation Centers of VHA’s Amputation System of Care (ASoC). The ASoC provides specialized expertise in amputation rehabilitation, incorporating the latest practices in medical rehabilitation management, rehabilitation therapies, and advances in prosthetic technology.

Collaboration

In order to implement this Diffusion of Excellence Gold Status Practice across VA, the FLOW3 program is collaborating with QUERI evaluators through the QUERI Partnered Evaluation (PEI)  mechanism to assess the following in VISN 22 (VA Desert Pacific Healthcare Network) and VISN 9 (VA MidSouth Healthcare Network):

The FLOW3 system makes the prosthetic limb process more predictable and consistent, creating a high-quality experience for Veterans and staff.

  • Evaluate provider satisfaction with the FLOW3 system and with training materials and implementation of FLOW3.
  • Assess the impact of FLOW3 on Veterans’ experience with the process of receiving a prosthesis.
  • Evaluate system-level impacts of FLOW3 on the timeliness of the provision of prosthetic limbs to Veterans, efficiency of the process of ordering a prosthetic limb, cost of the provision of prosthetic limbs, and return on investment of implementing the FLOW3 system.

Findings from this national implementation evaluation will assess Veteran and provider outcomes to inform return-on-investment of the program. It also will help inform recommendations for implementation of system redesign using IT resources by identifying barriers and facilitators to implementation at existing FLOW3 sites, informing best practices for implementation and dissemination of similar system improvements.

For more information about the FLOW3 evaluation, please contact Chelsea Leonard (Chelsea.Leonard@va.gov ).

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