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National Center for Health Promotion and Disease Prevention

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HealthPOWER! Prevention News Fall 2015: Feature Article

Legacy of Accomplishment: NCP Celebrates 20 Years of Successes in VA Prevention

 

Brownstone BuildingWhen the VHA National Center for Health Promotion and Disease Prevention officially opened in Durham, North Carolina two decades ago, few could’ve predicted the important contributions it would make during a period of unprecedented transition in VA and VHA. Fast forward to 2015, as NCP celebrates its 20th Anniversary, and NCP’s story—from three-person field office to driving force in VA’s transformation of patient care—is one of multiple accomplishments and measurable success in promoting forward-looking, patient-centric preventive care for millions of Veterans.

Beginning, Growing

The history of a planned approach for VHA preventive services dates to 1983, when public law authorized VA to provide preventive health services to Veterans. In response, VHA organized a field advisory group, task force, and policy council to oversee these services, and prevention coordinators were appointed in VA facilities. Nine years later, Congress passed legislation requiring the establishment of a field-based VA Central Office (VACO) program office called the National Center for Preventive Health. Under this original name, NCP officially opened its program office in Durham in January 1995, and immediately began to “make the case for prevention” in VA.

3022 Croasdaile Drive“We started out with a handful of staff members, working out of small office with a limited budget,” recalls current Administrative Officer Pamela Frazier, who joined NCP under original Director Dr. Robert Sullivan (1995-99). “Over the next few years, NCP slowly grew in size and responsibility, and with that came important early accomplishments.” During this period, staff laid the blueprint for future NCP initiatives by conducting an annual Veterans Health Survey of preventive services (1997-99), developing the first VHA Handbooks and Program Guide (1996, 1999), and holding a first-ever National Summit on VA Health Promotion and Disease Prevention (1998). NCP also began the first of many highly productive partnerships: the Director became VHA liaison to the U.S. Preventive Services Task Force in 1999, and staff began holding regular conference calls with the Veterans Integrated Service Network (VISN) Preventive Medicine Leaders in 2000. Taking the lead in developing clinical prevention tools, NCP rolled out the first of many effective resources for clinicians, such as a quarterly newsletter for the field, Prevention Notes (1997; which became HealthPOWER! in 2001), and the “Flu Toolkit” (2002-05), a seminal clinical resource based on the recommendations of the National Advisory Committee on Immunization Practices (ACIP).

MOVE! Coach AppMoving Forward

Through changes in the responsibility and authority of the NCP’s Director in 2000, NCP staff continued to shape the vision for and practice of VA prevention that would culminate in today’s model of Veteran care. “An initial priority was addressing the high prevalence of overweight and obesity in the VA population,” explains current VA Chief Consultant for Preventive Medicine, Dr. Linda Kinsinger, who joined NCP’s staff in 2002 as Assistant Director of Policy, Program, Training and Education under former Director Dr. Steven Yevich (2001-05). “In the early 2000’s, we began an ongoing focus on weight management, and NCP developed a comprehensive weight management program for VHA—the MOVE!® Weight Management Program for Veterans. This ‘flagship program’ was piloted from 2003 to 2005, launched nationally in January 2006, and is a program of which we’re really proud.”

MOVE! WhiteboardKinsinger says that a program with MOVE!’s scope had not been attempted before, but was successful in part because it was implemented in VA. “NCP touched every aspect of MOVE!—conception, planning, launch, guidance, training, dissemination, and assessment,” she notes. “It’s a great example of what VA does well—develop, implement, and measure population-level health programs that are evidence-based, multi-disciplinary, collaborative, and patient-centered.”

Notably, MOVE! has kept up with Veterans’ needs by embracing change, as well as emerging technology and clinical practice. “Programs like TeleMOVE!, Telephone Lifestyle Coaching (TLC), ‘Be Active and MOVE!’ Clinical Video TeleHealth (CVT), and MOVE! Buddy have given Veterans and clinicians new ways to use MOVE!, and extended its reach and effectiveness,” says Dr. Ken Jones, NCP’s National Program Director for Weight Management/MOVE! from 2004 to 2014. “There’s no ‘magic pill’ for weight loss, and it’s often difficult to make the long-term lifestyle changes needed to control weight. So over the years, we made MOVE! as inclusive, convenient, and interactive as possible for Veterans.”

Dr. Linda Kinsinger“As of the summer 2015, over 650,000 Veterans have participated in MOVE!, and of the approximately 1 in 5 patients who had sustained, intense participation, most achieved stable weight loss,” notes Dr. Susan Raffa, NCP’s current National Program Director for Weight Management. “We know the program is having an impact on Veteran health, especially when you consider the large numbers of overweight/obese patients in VA. Additionally, NCP has stayed on the leading edge with the recent launch of MOVE! Coach, a self-guided weight-management program, available via mobile app, that’s helping Veterans set, meet, and maintain their weight and health goals by encouraging lasting, positive health behavior change.”

NCP HighlightsExpanding Reach

In 2004, NCP moved to its current Durham office and in 2005, Kinsinger became NCP’s Director; in 2007, her title changed to Chief Consultant for Preventive Medicine, VHA Office of Patient Care Services. During the mid-2000’s, NCP continued to expand its reach and influence, and fine-tuned prevention training and resources for VHA clinical staff. By 2006, NCP had initiated a program of monthly prevention topics and monthly prevention calls with guest speakers, and a new section of NCP, Veterans Health Education and Information (VHEI), was founded and staffed in 2007. Through 2010, NCP led the HealthierUS Veterans initiative, an important VA - U.S. Department of Health and Human Services collaboration on diabetes and obesity prevention. “It was an exciting time,” recall Rosemary Strickland and Susi Lewis, who joined the office in 2002 and 2000, respectively, and are currently on NCP’s MOVE! Team. “Many of our programs were coming of age, as was our support for the field, and the office was well-positioned for the organizational changes that were to come.”

TLC BadgeDuring this period of growth and change, Kinsinger says that a number of factors helped NCP successfully advance the quality and effectiveness of VA’s preventive health care services. “We always received great support and collaboration from field staff, leadership in the Office of Patient Care Services (PCS), and others in VACO. And of course, we’ve always had dedicated, forward-thinking people working at NCP,” she comments. “This helped us make a strong case for the value of prevention, implement programs that worked, and build on the success of our earlier initiatives. Also, at key points along the way, we’ve gotten the resources to enhance our programs and training even more.”

NCP Display BoardTaking the Initiative

In 2008-2009, NCP firmly established its role as the VHA office responsible for clinical preventive services guidance coordination. Office staff also completed a strategic plan—a well-timed exercise that prepared the office for the new direction and resources associated with then-Secretary Eric Shinseki’s VA Transformational Initiatives for the 21st Century (T21) in 2010. Through the sweeping changes of the T21 New Models of Care initiatives, NCP focused on promoting and enhancing evidence-based clinical preventive care in VHA. A “paradigm shift” was occurring in NCP, according to Kinsinger, as leadership turned the focus to health behavior change as a means for health promotion and disease prevention (HPDP). NCP also hired additional clinical staff (Associate Chief Consultant for Preventive Medicine, Dr. Michael Goldstein; National Program Manager for Health Behavior, Dr. Peg Dundon; and Communications Specialist Jay Shiffler) and more support staff for the new HPDP missions. Key NCP staff involved in transformational activities who have moved on to other positions or retired were Dr. Leila Kahwati (2004-2012), Terri Murphy (2008-2014), and Sue Diamond (2008-2015).

HLA BadgeNCP continued to promote and expand preventive care as it embarked on its own multi-component transformational initiative. 2010’s Preventive Care Program had several core elements: promote healthy living among Veterans, provide facility support for preventive care, train clinical staff in patient-centered communication, and develop additional HPDP resources for Veterans. “NCP took the lead in integrating HPDP into VHA’s then-new Patient-Aligned Care Teams (PACT), because we knew that prevention needed a stronger field presence to be successful,” explains Kinsinger. “Within a few years, HPDP committees were in nearly every facility, and key HPDP staff—HPDP Program Managers, Health Behavior Coordinators, Veterans Health Education Coordinators (VHECs), and MOVE! Coordinators—were present in most facilities and partnering with Primary Care colleagues to ensure that patients get the highest quality preventive care.”

Clinical Staff Guide to Health CoachingStrengthening Partnerships

Through the hard work and collaborations of many, NCP staff also have grown Prevention Policy and Practice in VA, which included developing a full set of VHA Guidance Statements for clinicians and clinical preventive services recommendations for patients. “To date, we’ve partnered with our Preventive Medicine Field Advisory Committee to update over 40 of these guidance statements, which provide clinicians with ‘one-stop stopping’ for guidance on VHA’s clinical preventive services and resources,” says NCP’s Deputy Chief Consultant for Prevention, Dr. Jane Kim, who joined NCP in 2013. “Combined with numerous national clinical reminders developed over the years and quality improvement projects on cancer screening, we’ve been able to create a set of preventive services policies for VHA that promotes current, evidence-based preventive care.” These initiatives have contributed to improved performance rates of cancer screening in VA. NCP just completed a successful, multi-site demonstration project on VA-wide implementation of lung cancer screening services that will inform VHA plans for wider dissemination of lung cancer screening.

Lynn Novorska, Sue Diamond, Sophia HurleyOne cornerstone of NCP’s approach to prevention—training providers in patient-centered communication techniques—has also benefitted thousands of clinicians and, in turn, their patients. “Since 2010, NCP staff have trained over 32,000 and 16,000 clinical staff in provider-patient communication, Patient Education: TEACH for Success (TEACH) course, and Motivational Interviewing, respectively, and supported ongoing clinician coaching education to further develop these skills,” explains Goldstein. “We’ve used a ‘train-the-trainer’ model, so staff have then passed on these critical skills to their peers. Local feedback on the value of this training has been overwhelmingly positive.”

Clinicial Staff Guide to Healthy Living MessagesRecent Successes

Enhancing patient-centered education and communication has also been an ongoing focus—and success—for the VHEI Program, according to current National Program Manager Dr. Rose Mary Pries, who helped launch the program. “We’ve used a coordinated, VA-wide approach to planning, delivering, and evaluating evidence-based, Veteran-centric health education and information, which also takes into account Veterans’ unique health literacy and numeracy needs,” she explains. “After almost 10 years of VHEI programs, services, and products, and professional development, support, and training for VHECs, VA facilities are effectively delivering—through tools like the Veterans Health Library (VHL)—the educational programs and information that Veterans need to partner with their health care teams to enhance and self-manage their health.”

Veterans Health Library badgeSeveral of NCP’s more recent programs demonstrate just how far the office has come from its humble origins two decades ago. These include NCP’s Healthy Living initiative (begun in 2010-11), which includes 9 key Healthy Living messages and the popular My Health Choices goal-setting tool; the comprehensive VHL (2013), which has had over 2.5 million page views on MyHealtheVet; and the online HealtheLiving Assessment (HLA; 2014), a health risk assessment tool that over 36,000 Veterans have used to understand and reduce their risk of certain diseases. In 2015, in Kinsinger’s tenth year of leadership, NCP also launched the Gateway to Healthy Living pilot program, a brief lifestyle intervention session for PACT patients. NCP recently submitted a proposal for a national Telephone Lifestyle Coaching program, which, in a 2-year pilot, was shown to help Veterans successfully improve key health behaviors through phone-based health coaching. “These innovative products are the culmination of years of planning and testing,” notes Kinsinger, “and we’re excited to continue offer effective, patient-driven resources that provide measureable improvement and long-term value in Veteran health.”

MOVE! Healthy PlateLasting Legacy

Moving beyond 2015, NCP will continue to develop and enhance its many ongoing HPDP initiatives and resources, and sustain a longstanding legacy of health promotion and disease prevention that supports VA's ever-improving and evolving vision for Veteran care. “The challenge in preventive care is that you typically can’t see the things you prevent, and you often don’t get specific or dramatic results that indicate success,” explains Kinsinger. “Prevention is applied at the individual level, but needs to be viewed and assessed at the population level, with a long-term view and reliance on data to show impacts. But we’re confident that the foundations and interventions of preventive care that VA and NCP have laid over the past two decades will help achieve those impacts, and help guide Veterans in improving their health and well-being for years to come.”

 

Prevention Milestones: NCP Over the Years

 
  • 1996 - First VA Handbook (1101.8); first Preventive Medicine Conference
  • 1997 - Veterans Health Survey begins; first NCP newsletter published
  • 1998 - National Summit on VA Health Promotion and Disease Prevention
  • 1999 - Director becomes VHA liaison to the US Preventive Services Task Force
  • 2002 - Flu Toolkit published
  • 2003 - MOVE! pilot starts
  • 2004 - First Annual Report published; office moved to current location
  • 2006 - Office restructured, moved on PCS org chart; title of Director cha nged to Chief Consultant; MOVE! launched nationally; monthly prevention topics developed; monthly prevention calls began
  • 2007 - VHEI Program launched
  • 2009 - Tagline, “Keeping Well and Well-Informed,” debuted
  • 2010 - Preventive Care Program sub-initiative of T21 begins; HPDP staff positions funded at local facilities; TEACH and MI trainings began
  • 2011 - Healthy Living messages campaign launched
  • 2012 - National TLC pilot, Diabetes Prevention (DPP) pilot and Lung Cancer Screening Demonstration Project pilot launched
  • 2013 - VHL launched
  • 2014 - HLA launched
  • 2015 - MOVE! Coach Mobile and Gateway to Healthy Living launched

 

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