Five Questions With: Dr. James Rudolph

Dr. James Rudolph is director of the Center of Innovation in Geriatric Services and director of Measurement and Quality Improvement for the VA Office of Geriatrics and Extended Care, both at the Providence VA Medical Center. He is overseeing a $2.8 million grant from the VA. / COURTESY WINFIELD DANIELSON, PROVIDENCE VA MEDICAL CENTER
Dr. James Rudolph is director of the Center of Innovation in Geriatric Services and director of Measurement and Quality Improvement for the VA Office of Geriatrics and Extended Care, both at the Providence VA Medical Center. He is overseeing a $2.8 million grant from the VA. / COURTESY WINFIELD DANIELSON, PROVIDENCE VA MEDICAL CENTER

Dr. James Rudolph is director of the Center of Innovation in Geriatric Services and director of Measurement and Quality Improvement for the VA Office of Geriatrics and Extended Care, both at the Providence VA Medical Center. Rudolph’s pioneering program, the VA Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans, designed to meet the needs of the nation’s aging veterans – was recently awarded a five-year, $2.8 million grant from the Veterans Administration Health Services Research and Development.

A geriatrician and palliative care physician at the Providence VAMC, Rudolph is an associate professor of medicine at The Warren Alpert School of Medicine at Brown University. His career focus as a physician and a researcher is improving care for older patients, and he is deeply passionate about VA leading the nation in this area. His area of expertise is the relationship of functional cognitive and physical deficits as a predisposition to negative health events in older persons, particularly those who are hospitalized.

A clinician working with interdisciplinary teams to implement programs to improve patient care with a focus on returning patients’ functions, he talked recently with Providence Business News about the unique health care needs of veterans, the focus of the grant and the Providence VA Medical Center’s affiliations with Brown and the University of Rhode Island on this initiative, whose funding will continue the research through fiscal 2021.

PBN: Can you explain the goals and objectives of the Providence VA’s Long-Term Services and Supports for Vulnerable Veterans; is this a program you’ve created or one that exists at other VA hospitals around the country?

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RUDOLPH: We are the only Center of Innovation with a focus on LTSS within VA. The program has been developing over the past two years, and this grant award for five additional years of funding allows us to make investments in LTSS program measurement, implementation and quality.

The mission of the Center of Innovation is to develop research on measurement and implementation, and improve the quality of VA LTSS to enhance the value of the care delivered to our vulnerable veterans.

PBN: Who are “vulnerable veterans,” what makes them vulnerable and how large a cohort do they represent?

RUDOLPH: Vulnerable veterans are those at risk of losing their independence. Fundamentally, it is more veteran-centric to develop and implement programs to keep veterans in their homes and community than caring for them in a nursing facility. Our research focuses on measuring the quality and demonstrating the value of these programs. We are also very interested in measuring and improving the quality of care for veterans in nursing facilities and palliative care settings.

PBN: How are veterans’ medical and health care issues different than those of their nonveteran peers; might the outcomes derived from this grant have applicability to the larger, nonveteran population?

RUDOLPH: As we accumulate years, we have a tendency also to accumulate medical conditions. In our view, this accumulation decreases the ability of these veterans to rebound after a stressful event, like hospitalization. For example, a patient with many medical conditions is probably going to have a more difficult time returning home after experiencing pneumonia (or surgery, heart attack, stroke or cancer diagnosis, etc.). Veterans tend to be a group who accumulate more medical conditions, in addition to their military-related conditions.

By evaluating programs focused on preserving veterans’ function in the community, we are optimistic that these programs could be duplicated in the rapidly aging nonveteran population.

PBN: How will the Providence VA implement this five-year $2.8 million grant? What do you hope to achieve?

RUDOLPH: We are off to a running start. We have four primary goals: First, to improve LTSS quality, safety and value; second, to develop cross-collaborations with related fields; third, to develop new research expertise in LTSS and, finally, to develop collaborations with organizations that are similarly interested in LTSS.

We have several new research programs focused on measurement of LTSS programs throughout the VA.

We are actively engaged with investigators from the Providence VAMC, Brown University and the University of Rhode Island with related interests in such fields as cardiology, mental health, infectious disease and homeless programs. Patients experiencing any one or more of these conditions are more frequent users of LTSS.

As one might suspect, LTSS research is not on the top of the list of ‘flashy research programs’ – we do not have robotics, scans, scopes genes or molecules. Students interested in research are not breaking down the doors to develop expertise in LTSS, which, in my opinion, is shortsighted on their part. Our goal is to develop a cadre of researchers at the Providence VAMC, Brown and URI with this expertise so that we can continue to lead VA and the nation in LTSS research.

Finally, we are reaching out to community and federal organizations who are interested in LTSS, because we have the opportunity to use our work to increase knowledge and management in similar non-VA programs.

PBN: What roles will the Providence VA’s research partners, Brown University’s Center for Gerontology and the University of Rhode Island, play in this grant?

RUDOLPH: Many of our investigators have appointments at the academic affiliates, so there is natural collaboration and synergy. In the LTSS arena, the Brown Center for Gerontology has been the national leader for decades, and our strong collaboration and partnership with them enhances both programs. The University of Rhode Island’s School of Pharmacy is a pillar in the area of antimicrobial stewardship – using medicines appropriately to treat infection and improve patient outcomes while minimizing the risk of multi-drug-resistant microbes – and there has been a strong collaboration to bring this expertise into the VA.

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