Boston VA Medical Center
The VA Boston Health Care System (VABHCS) is the major tertiary care center for the New England Region. It hosts a number clinical centers of excellence, advanced technology and research initiatives while providing primary care to patients from southern New Hampshire, Cape Cod and a large segment of eastern Massachusetts. The product of a merger between two formerly separate VA Hospitals, the current VABHCS is dispersed among three primary campuses, and runs six additional community based outpatient clinics. The West Roxbury campus houses all acute inpatient services except psychiatry. Cardiology and Pulmonary section activities are concentrated there as well. The Jamaica Plain campus houses a cancer center, endoscopy suite, a chronic dialysis unit the majority of subspecialty clinics in medicine and surgery as well as an ambulatory surgical center. The Brockton campus is the site of hospice, transitional care, and chronic care units as well as the acute inpatient psychiatry service. Our local VA is a major affiliate of Boston University School of Medicine and Harvard Medical School as well as several other academic and health care education institutions. It is a major training center for students and housestaff and a vibrant center of medical investigation.
Research Activities VABHCS Medical Service investigators are successful in obtaining Department of Veterans Affairs (VA) and National Institutes of Health (NIH) funding. Bench, epidemiologic, health services and clinical research are all active in the Medical Service. Every clinical section in Medicine has ongoing research efforts.
MAVERIC, the Massachusetts Veterans Epidemiology Research and Information Center is the largest hub of research activities within medicine with more than 125 staff. MAVERIC is involved in a variety epidemiological studies and clinical trials. The unit has more than 20 individually funded projects. It also houses a serum and tissue repository to support VA investigators across the country. The newly launched MVP – Million Veteran Program is a major new initiative in genetic epidemiology. MVP will collect serum and DNA samples from 1,000,000 veterans across the country and will be able to link to clinical data within the VA’s nationwide electronic medical record. The unit also lays claim to expertise in multi-site clinical trials and is one of a select few Clinical Trials Coordinating Centers nationally in the VA Cooperative Studies Program. Over half of the sections in Medical Service have staff leading or collaborating on research projects in MAVERIC. Cross disciplinary research, particularly with colleagues in mental health is vibrant.
There are many unique centers of excellence in investigation and individual experts which call VABHCS home. The Center for Organization, Leadership, and Management Research (COLMR), the National Center for Post-Traumatic Stress Disorder, and the center for Health Care Financing and Economics (HCFE) are examples of locale expertise that welcome collaboration.
Clinical Activities VABHCS provides tertiary care for 5 New England States. The Medical Service leads major clinical programs to support care to patients across this broad region. Programs include a cancer center, a diagnostic and interventional cardiac catheterization laboratory, an electrophysiology lab, a clinical heart failure program and high tech endoscopy unit are a few examples of state of the art clinical programs. The gastroenterology section was the first in the city of Boston to utilize endoscopic ultrasound in diagnosis and to apply photodynamic therapy to the treatment of esophageal malignancies. VABHCS is home to one of only 8 Women’s Health Centers of Excellence. This program provides comprehensive clinical care, and runs a women’s health fellowship program in collaboration with BU’s Women’s Health Center of Excellence. In Fiscal year 2009 VA Boston was rated # 1 in the country in meeting performance measures compared to all VA medical centers as well those with our level of complexity. In addition VA Boston was a positive outlier in our hospital and ICU mortality and had a surgical mortality half that of the VA average. VA Boston is truly a place of excellent care.
Homecare for the homebound elderly, a telehealth program which provides computer technology in a patient’s home to assist in managing chronic disease in severely ill patients, and a nation wide, comprehensive electronic medical record exemplify the VA’s ability to provide human and technological resources in the care of veteran’s throughout the region.
In 2009 VA Boston was one of three facilities to receive funding to launch a Veterans Engineering Resource Center (VERC). The New England Healthcare Engineering Partnership (NEHCEP) is a collaborative effort of VA and Northeastern University, Massachusetts Institute of Technology and Worcester Polytechnic Institute. These latter institutions bring expertise in systems engineering and work collaboratively with VA clinical and administrative leadership to further improve hospital systems. The medical residency and medical students are also involved as they benefit from training in systems based quality improvement projects.
Education in many areas that related to health care. Students from two medical schools and three residency programs in Boston come together on the clinical service of the VABHCS to create a stimulating academic environment. Boston Medical Center, Brigham and Women’s Hospital, and Beth Israel Deaconess Medical Center each send residents to train on the inpatient service and ambulatory clinics. Boston University has the largest representation with more than 50% of the slots for students, residents and fellows filled by trainees matriculated in BU affiliated programs. Housestaff are assigned to teams regardless of affiliation and work well together. Five general medicine teams, and a double size cardiovascular medicine service, along with an MICU comprise the inpatient medical service.
In addition to sponsoring residency training, the VABHCS runs on site physical diagnoses courses for second year students from both BU and Harvard and trains 3rd year and 4th year clerks on the wards in the ambulatory setting. All subspecialties send fellows to train here as well.
The VA has long been a site for educational innovation, experimentation and a based for faculty committed to educational excellence. VA based faculty have leadership responsibilities in major educational programs for students, residents and fellows. Hence the VA is an active partner in planning and running these vital educational experiences. Cross fertilization of staff from VA to the affiliates and visa versa ensures the highest quality clinical teaching for all trainees. Ubiquitous access to electronic and library resources compliment the human resources to ensure expeditious access to up to date information meeting the learning needs of trainees. Novel conferences and unique clinical rotations, such as the highly recognized Patient Safety Rotation for Senior Resident and the ADTC –Ambulatory Diagnostic and Treatment Center, take full advantage of the educational opportunities afforded by caring for a patient population that is varied and complex in its burden of illness in an energetic academically vibrant facility.