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Introducing SALUTE: Ensuring Equitable Healthcare for Veterans

Introducing SALUTE: Ensuring Equitable Healthcare for Veterans

Designing a healthcare delivery system that ensures equitable care for all patients is crucial for achieving total systems safety. This includes building partnerships among patients, families, and healthcare providers to codesign care and involve patients in decision-making and improving healthcare safety, particularly in terms of diagnostic safety. This collaboration facilitates shared decision-making, enhances diagnostic safety, and ultimately improves patient outcomes. Research indicates that diagnostic errors alone account for nearly 60% of all medical errors. Recognizing this, initiatives like the National Action Plan to Advance Patient Safety prioritize patient and family engagement as foundational drivers; yet, barriers, such as limited resources, exist at the provider-patient level. This is especially challenging when working with vulnerable populations, such as veterans, who may have unique health needs that are not always recognized in civilian healthcare settings. By defining roles in the partnership and enhancing communication and awareness of service-related health risks, providers and patients can work together towards shared decision-making and diagnostic safety.

Veteran Health

Veterans face a myriad of health issues stemming from their military service, both physical and emotional. From combat-related injuries like limb loss to mental health conditions such as posttraumatic stress disorder, the impact of military service on veterans' health is profound. Studies have shown that a significant percentage of OEF, OIF, and Operation New Dawn veterans have received mental health diagnoses, including depression, anxiety, posttraumatic stress disorder, self-harm, and thoughts of suicide. These conditions can be caused by the stress of multiple deployments, traumatic injuries, and sexual harassment or assault while in the military. Health disparities exist among veterans, with Black and Hispanic veterans more likely to be diagnosed with certain conditions compared to White veterans. Female veterans have higher rates of depression than male veterans, and older veterans tend to receive better healthcare across various categories compared to younger veterans.

Despite the VA health system's efforts to cater to veterans' unique needs, challenges persist, particularly for veterans seeking care outside the VA system. In addition to resource constraints, barriers to effective provider-patient partnerships include a lack of awareness about service-related health risks. Bridging these gaps requires a proactive approach to shared decision-making and diagnostic safety.

A Total Systems Approach

By incorporating principles of system design, human factors, advanced safety science, and health equity, a comprehensive approach to safety can improve efficiency and resilience in clinical and safety operations that directly affect patients. Leaders in both civilian and VA healthcare should analyze system factors that contribute to deficiencies in assessing and managing veterans' unique health needs. These deficiencies can occur at various levels of the healthcare system, such as when providers do not inquire about a patient's military service during interactions, or when educational institutions do not adequately prepare healthcare professionals to address veterans' specific health requirements. Addressing these issues necessitates redesigning the physical care environment, evaluating care delivery tasks and processes, and creating technology and tools to support the healthcare system's organization and its workforce.

Introducing SALUTETM

In order to assist healthcare providers in improving care for veterans, ECRI is introducing the SALUTE Program. This program encourages healthcare leaders and providers to collaborate with military veterans, their families, and caregivers to ensure patient safety. This partnership is a key aspect of ECRI's Total Systems Safety approach and is crucial for enhancing diagnostic safety. By implementing ECRI's SALUTE tools, healthcare organizations can revamp the provider-patient relationship and utilize evidence-based tools to empower military veterans to advocate for their own healthcare needs, and assist healthcare providers in making precise assessments, diagnoses, and treatment plans for individuals at a higher risk of service-related injuries. These user-friendly tools, based on the Toolkit for Engaging Patients to Improve Diagnostic Safety from the Agency for Healthcare Research and Quality, enable essential discussions between veterans and healthcare providers about patients' military background and potential health risks related to their service. They facilitate effective communication and allow providers to gather necessary information through screening questions and dialogue. Based on the veteran's health objectives, the provider can suggest appropriate next steps, including diagnostic testing. Veterans interested in learning about VA health benefits can also be directed to relevant resources.

Next Steps

Equitable healthcare for veterans is a shared responsibility that requires a collaborative effort from healthcare providers, patients, and families. By strengthening provider-patient partnerships and leveraging innovative initiatives, we can ensure that veterans receive the quality care they deserve. Let's continue striving towards a healthcare system that honors the sacrifices of those who have served.

Download the SALUTE Toolkit to start improving veterans’ health through a Total Systems Safety approach.