Patient satisfaction as a function of in-house versus contract staffing models in Veterans Affairs community-based outpatient clinics.

As part of decision support for Central Arkansas Veterans Healthcare System, this research evaluated patient satisfaction differences associated with contract versus Veterans Affairs (VA) staffing of community-based outpatient clinics (CBOCs). The research question was as follows: What differences exist between contract versus VA-staffed outpatient clinics in the areas of patient perceptions of access, continuity of care, courtesy, education and information, emotional support, overall coordination, visit coordination, and patient preferences? The quarterly Survey of Healthcare Experiences of Patients provided satisfaction data necessary for this study. Results of Bonferonni-corrected z-tests of proportions indicated that the VA-staffed CBOCs had statistically higher scores for continuity of care, education and information, emotional support, overall coordination, and patient preferences. No statistically significant difference emerged for patient perception of access, courtesy, and visit coordination. The lack of finding associated with visit coordination coupled with the statistically significant difference for overall coordination suggests that coordination for non-VA-staffed CBOCs erodes after the patient encounter. In toto, patients reported higher satisfaction with in-house staffing solutions versus contractor solutions. The authors recommend additional cost-utility research to identify which of the two models, VA-staffed or non-VA-staffed, best meets the needs of all stakeholders.