Justin K Benzer1,2, Deborah Gurewich3,4, Sara J Singer5, Nathalie M McIntosh6, David C Mohr3,7, Varsha G Vimalananda8,9, Martin P Charns3,7. 1. VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Healthcare System, Waco. 2. Department of Psychiatry, The University of Texas at Austin, Dell Medical School, Austin, TX. 3. Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System. 4. Boston University School of Medicine, Boston Medical Center, Boston, MA. 5. Stanford School of Medicine and Graduate School of Business, Stanford, CA. 6. Massachusetts Health Quality Partners, Watertown, MA. 7. Department of Health Policy and Management, Boston University School of Public Health, Boston. 8. Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford. 9. Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA.
Abstract
BACKGROUND: Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans' access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. OBJECTIVE: The objective of this study was to determine VA patients' and clinicians' experiences of coordination across VA and non-VA settings. DESIGN: Observational mixed methods using patient surveys and clinician interviews. Sampled patients were diagnosed with type 2 diabetes mellitus and either cardiovascular or mental health comorbidities. PARTICIPANTS AND MEASURES: Patient perspectives on coordination were elicited between April and September 2016 through a national survey supplemented with VA administrative records (N=5372). Coordination was measured with the 8-dimension Patient Perceptions of Integrated Care survey. Receipt of non-VA care was measured through patient self-report. Clinician perspectives were elicited through individual interviews (N=100) between May and October 2017. RESULTS: Veterans who received both VA and non-VA care reported significantly worse care coordination experiences than Veterans who only receive care in VA. Clinicians report limited information exchange capabilities, which, combined with bureaucratic and opaque procedures, adversely impact clinical decision-making. CONCLUSIONS: VA is working through a shift in how Veterans receive health care by increasing access to care from non-VA providers. Study findings suggest that VA should prioritize coordination of care in addition to access. This could include requiring monitoring of patient-experienced care coordination, surveys of referring and consulting clinicians, and pilot testing and evaluation of interventions to improve coordination.
BACKGROUND: Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans' access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. OBJECTIVE: The objective of this study was to determine VA patients' and clinicians' experiences of coordination across VA and non-VA settings. DESIGN: Observational mixed methods using patient surveys and clinician interviews. Sampled patients were diagnosed with type 2 diabetes mellitus and either cardiovascular or mental health comorbidities. PARTICIPANTS AND MEASURES: Patient perspectives on coordination were elicited between April and September 2016 through a national survey supplemented with VA administrative records (N=5372). Coordination was measured with the 8-dimension Patient Perceptions of Integrated Care survey. Receipt of non-VA care was measured through patient self-report. Clinician perspectives were elicited through individual interviews (N=100) between May and October 2017. RESULTS: Veterans who received both VA and non-VA care reported significantly worse care coordination experiences than Veterans who only receive care in VA. Clinicians report limited information exchange capabilities, which, combined with bureaucratic and opaque procedures, adversely impact clinical decision-making. CONCLUSIONS: VA is working through a shift in how Veterans receive health care by increasing access to care from non-VA providers. Study findings suggest that VA should prioritize coordination of care in addition to access. This could include requiring monitoring of patient-experienced care coordination, surveys of referring and consulting clinicians, and pilot testing and evaluation of interventions to improve coordination.
Authors: Sara J Singer; Anna D Sinaiko; Maike V Tietschert; Michaela Kerrissey; Russell S Phillips; Veronique Martin; Grace Joseph; Hassina Bahadurzada; Denis Agniel Journal: Health Serv Res Date: 2020-12 Impact factor: 3.402
Authors: Audrey L Jones; Adam J Gordon; Sonya E Gabrielian; Ann Elizabeth Montgomery; John R Blosnich; Allyson L Varley; Aerin J deRussy; Erika L Austin; April E Hoge; Young-Il Kim; Lillian Gelberg; Stefan G Kertesz Journal: Med Care Date: 2021-06-01 Impact factor: 3.178