Access to care for vulnerable veterans with hepatitis C: a hybrid conceptual framework and a case study to guide translation.

The Veterans Health Administration (VHA) is the largest single provider of medical care to people with hepatitis C (HCV) in the USA. Given the advent of promising new HCV therapies, the VHA is now faced with a large number of chronically HCV-infected veterans with concomitant psychiatric or substance use comorbid conditions who will need to either be retreated or newly treated for HCV or will require management for chronic liver disease. There is a critical need in the VHA for behavioral medicine and hepatology specialists, along with infectious disease and primary care providers with an interest in hepatitis C, to provide coordinated care for these complex patients. The VHA Health Services Research and Development Service has advocated for the application of strong implementation science theories and methods to translate new models of healthcare delivery in clinical practice. To inform the delivery and evaluation of integrated behavioral medicine and specialty care for vulnerable patient populations, we sought to develop an enriched framework which incorporates implementation science theory and strong conceptual models for access to care. In this paper, we present a hybrid conceptual framework that accomplishes this goal. To illustrate how this hybrid model could inform the translation of a novel method of healthcare delivery, we provide a case study of a VHA initiative to improve access to integrated behavioral medicine and specialty care among veterans with HCV.