Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies

Zuchowski, Jessica L.; Chrystal, Joya G.; Hamilton, Alison B.; Patton, Elizabeth W.; Zephyrin, Laurie; Yano, Elizabeth M.; Cordasco, Kristina M.

doi:10.1097/mlr.0000000000000737

Cited by 58 publications

(50 citation statements)

References 46 publications

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“…13 Both VA and non-VA providers have reported significant frustration with crosssystem care coordination, particularly related to barriers to information exchange and a lack of role clarity and care tracking. [14][15][16][17] Health information technology (IT) has been shown to be an essential part of effective information exchange, but is itself highly complex and reflects only one component of achieving coordinated care. 18,19…”

Section: Current Evidence On Cross-system Care Coordinationmentioning

confidence: 99%

“…Early research of VCP implementation found that there were communication difficulties among stakeholders (e.g., VHA, third-party administrators, community providers, and patients), slow or incomplete exchange of medical records, network provider shortages, and concurrent barriers to community provider participation. 3,14,17,29,30 The number of providers, providers' distribution across specialties (i.e., health professional shortage areas), locations of existing providers (e.g., clusters in urban vs. rural areas), and provider preferences (e.g., capacity to accept new patients, reimbursement limits) are not necessarily aligned with optimal care and coordination and so need further evaluation. Careful assessment of where current provider networks are inadequate, and for what specialties, will be required to support targeted network development toward the goal of increasing long-term capacity for delivery of community care.…”

Section: Care Coordination Measurement Systemsmentioning

confidence: 99%

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Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

et al. 2019

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Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination. KEY WORDS: Veterans; care coordination; health information interoperability; delivery of healthcare.

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Section: Current Evidence On Cross-system Care Coordinationmentioning

confidence: 99%

Section: Care Coordination Measurement Systemsmentioning

confidence: 99%

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

et al. 2019

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“…In particular, increased fragmentation of care may result in additional challenges for coordination and continuity of care provided . The impact of increased care fragmentation is expected to be more pronounced for Veterans with greater health care utilization, and among them women Veterans, who have additional health burdens and complex care needs …”

Section: Introductionmentioning

confidence: 99%

“…3 The impact of increased care fragmentation is expected to be more pronounced for Veterans with greater health care utilization, and among them women Veterans, who have additional health burdens and complex care needs. 4,5 Women Veterans (WVs) constitute the fastest growing segment of VA patients, but represent a numerical minority within VA facilities (<10 percent of VA users). 6 Delivering women's health (WH) services, maintaining provider competencies in WH, and providing gender-sensitive care environments have been challenging for VA facilities traditionally oriented toward the care of male patients.…”

Section: Introductionmentioning

confidence: 99%

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Chanfreau‐Coffinier

Washington

Chuang

et al. 2019

Health Services Research

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Objective To examine the relationship between care fragmentation and patient ratings of care quality and identify potentially actionable mediators. Data Sources/Study Setting 2015 telephone survey of 1395 women Veterans with three or more visits in primary care and/or women's health care in the prior year at 12 Veterans Affairs (VA) medical centers. Study Design Cross‐sectional analysis. Data Collection/Extraction Methods We operationalized lower care fragmentation as receiving VA‐only care versus dual use of VA/non‐VA care. Participants rated VA care quality (overall care, women's health care (WH), and primary care (PC)) and three aspects of their patient experience (ease of access to services, provider communication, and gender sensitivity of VA environments). We examined associations between care fragmentation and care ratings and applied the Karlson‐Holm‐Breen decomposition method to test for mediation by aspects of patients’ experience. Principal Findings Lower care fragmentation was associated with higher ratings of care quality (odds ratios [95% CI] for overall care: 1.57 [1.14;2.17]; WH: 1.65 [1.20;2.27]; PC: 1.41 [1.10;1.82]). Relationships were mediated by patient‐rated provider communication and gender sensitivity (26‐54 percent and 14‐15 percent of total effects, respectively). Ease of access was associated with higher care ratings (odds ratios [95% CI] for overall care: 2.93 [2.25;3.81]; WH: 2.81 [2.15;3.68]; PC: 2.33 [1.63;3.33], in models with the three types of patient care experiences included), but did not mediate the association of care fragmentation and care ratings. Conclusions Potential negative effects of care fragmentation on care quality ratings could be mitigated by attention to quality of patient‐provider communication and gender sensitivity of VA environments.

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“…Our findings provide quantitative support to qualitative studies that have elucidated care coordination challenges by women veterans using non-VA care for some of their health needs. 4,19 However, further attention needs to be given to those veterans with poor integrated care scores, specifically as to whether these veterans have worse health outcomes than veterans with high integration. Furthermore, echoing previous studies, 20 our study also points to the need to ensure non-VA care providers are provided sufficient medical information on women veterans in their care and should underscore efforts for the VA to be more collaborative in its relationships with community providers.…”

Section: Discussionmentioning

confidence: 99%

Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach

et al. 2019

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BACKGROUND: An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits. METHODS: We fielded a modified version of the Patient Perceptions of Integrated Care survey among a sample of postpartum veterans who had utilized VA maternity benefits for their pregnancies (n = 276). We assessed relationships between perceptions of six domains of patientreported integrated care, indicating how well-integrated patients perceived the care received from VA and non-VA clinicians, and utilization of mental healthcare following pregnancy. RESULTS: Domain scores were highest for items focused on VA care, including test result communication and VA provider's knowledge of patient's medical conditions. Scores were lower for obstetrician's knowledge of patient's medical history. Women with depressive symptom scores indicative of depression rated test result communication as highly integrated, while women who received mental healthcare following pregnancy had low integrated care ratings for the Support for Medication and Home Health Management domain, indicating a lack of support for mental health conditions following pregnancy. DISCUSSION: Among a group of postpartum veterans, poor ratings of integrated care across some domains were associated with higher rates of mental healthcare use following pregnancy. Further assessment of integrated care by patients may assist VA providers and policymakers in developing systems to ensure integrated care for veterans who receive care outside the VA.

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Coordinating Care Across Health Care Systems for Veterans With Gynecologic Malignancies

Abstract: Experiences in coordinating care for women Veterans with gynecologic malignancies receiving concurrent VA and community cancer care reveal challenges inherent in delivering care across health care systems, as well as potential approaches for addressing them.

Cited by 58 publications

References 46 publications

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

Exploring the association of care fragmentation and patient ratings of care quality: A mediation analysis of women Veterans’ experience with VA care

Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach

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