Implementation of the Epilepsy Center of Excellence to improve access to and quality of care--protocol for a mixed methods study.
BACKGROUND
To address the growing problem of epilepsy among aging Veterans and younger Veterans who have experienced a traumatic brain injury (TBI), the Veterans Health Administration (VA) has implemented 16 Epilepsy Centers of Excellence (ECOE) to assure increased access to high quality of care for Veterans with epilepsy. Each ECOE consists of a network of regional hubs to which spoke facilities refer Veterans for subspecialty treatment. The ECOEs are expected to improve access to and quality of epilepsy care through patient care, consultation and education. This study aims to: evaluate the effectiveness of the ECOE structure by describing changes in the quality of and access to care for epilepsy before and after the ECOE initiative using QUality Indicators in Epilepsy Treatment (QUIET Indicators); describe associations between changes in the structure and processes of care and Relational Coordination (RC), a model of task-oriented communication that has been shown to play a role in implementation science; and determine if variations in care are related to levels of RC.


METHODS
This four-year comparative case study uses a mixed-methods approach. We will use VA inpatient, outpatient, pharmacy, and chart abstraction data to identify changes in the quality of and access to epilepsy care in the VA between Fiscal Year 2008 and Fiscal Year 2014. Qualitative and survey methods will be used to identify changes in the structure and processes of epilepsy care and RC over the course of the study. We will then link data from the first two objectives to determine the extent to which quality of and access to epilepsy care is associated with RC using multivariable models.


CONCLUSIONS
This innovative study has the potential to improve understanding of hub-and-spoke model effectiveness, VA epilepsy care, and models of epilepsy specialty care more globally. Moreover, it contributes to implementation science by advancing understanding of the role of RC in the context of a major transformation in the structure of care delivery in a national integrated healthcare system.
South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, 7400 Merton Minter BLVD, San Antonio, TX 78229, USA. Maryjo.Pugh2@va.gov.
Mary Jo
MJ
Pugh
Luci K
LK
Leykum
Holly J
HJ
Lanham
Erin P
EP
Finley
Polly H
PH
Noël
Katharine K
KK
McMillan
Jacqueline A
JA
Pugh
D001930:Brain Injuries / Q000150:complications; D004827:Epilepsy / Q000209:etiology / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D014728:Veterans