Exposure Ed

Background: Providing care for individuals with environmental and occupational exposure health concerns is challenging. There is rarely exposure data to allow for verification of dose and duration of exposure, and even when there is, it is difficult to conclusively determine if or to what degree a health condition is associated with an exposure. This uncertainty can lead to disagreement between patients and providers, lowering trust and satisfaction. To address these issues the Veterans Affairs (VA) has developed, and is implementing, Exposure-Informed Care (EIC). EIC is a model of care that recognizes previous possible or known exposures to environmental factors may impact health and cause concern and seeks to create an environment that at every level is validating, transparent, and proactively addresses environmental exposures. Objectives: This paper provides a framework for how the VA has implemented the core features of EIC that can be adapted by other health care systems. Results: The VA has implemented EIC through: (1) screening for potential exposures and integration of exposure-related information into clinical care, risk communications, and trust building; (2) trained clinicians to provide evaluations and consultation; (3) surveillance and research; (4) investment and commitment to workforce development by providing education and implementation support and evaluating the impact of these efforts; (5) leadership commitment to standardize institutional policies and create cultural change. Discussion: While this paper focuses on a single health care system, EIC principles can and should be adapted to clinical settings outside of the VA. This is important for Veterans seen in community care as well as civilian populations who are likely to have been exposed to environmental hazards.