VA - Patient Centered Medical Home

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Hi!

I was wondering if anyone has had any experience as a RN CCM in the VA system that is currently using the patient centered medical home model of practice.

Can you describe some of your duties? How are the patients responding to this model? How do you like this model? What do you identify as Pros/Cons?

Thanks for your feedback.

Specializes in EMT, ER, Homehealth, OR.

I worked for about a year in the VA's home health program (home based primary care). Unlike medicare homehealth which is get in and get out the VA program is for the long term to keep vets out of the hospital and the ER. You are the go between for the vet and their provider. It is a enjoyable position, with some vets you are their only contact with anyone. Generally you will go to the vets home every 2-3 weeks for a assessment, filling of pill box etc., frequently they will call the office with issues. Since you are able to handle them and contact the provider for them they are ensured prompt treatment. At the VA I worked at we decreased the number of unscheduled clinic visits, ER visits and admissions to the hospital thus improving the vets quality of life.

On down side as with any homehealth nursing is that some of the homes you go into are not in the best of conditions or the best of neighborhood.

One thing you will learn at the VA is on VISN will call a program one thing and another VISN will call it something else.

Thanks for the reply jeckrn...

I, too, used to do home care, but in Manhattan.

This "patient centered home" is a new pilot program for the VA (check it out on the web). It attempts to restructure the health care delivery system. Its a very innovative concept and appears to be the delivery system of the future.

My role will be as CCM for a localized vet population. Maybe its so new that there may not be others out there who have been introduced to it yet.

Thanks again!

Specializes in EMT, ER, Homehealth, OR.

Is it a pilot program for your area or the whole VA. If it is new it sounds like it is improving on the Home Base Primary Care program.

Specializes in Med-Surg, Geriatrics, Ambulatory Care.

by CCM do you mean care coordinator?

I just accepted a position for a pilot Patient Centered Medical Home in Atlanta, GA as the RN Care Coordinator.

I'm very excited. I'll be helping to coordinate follow up care and help patients manage their chronic illnesses independently and in conjunction with their PCP.

:)

Hi myjo

I know this is an old post however I am going through the hiring process with the VA in Manhattan. I was hoping you could give me some information regarding the facility ie staffing nurses environment how long the hiring process usually take...

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