Non-VA Primary Care Providers' Perspectives on Comanagement for Rural Veterans

Gaglioti, Anne H.; Cozad, Ashley J; Wittrock, Stacy; Stewart, Kenda R.; Lampman, Michelle A.; Ono, Sarah S.; Reisinger, Heather Schacht; Charlton, Mary E.

doi:10.7205/milmed-d-13-00342

Cited by 38 publications

(43 citation statements)

References 9 publications

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“…The increase in care fragmentation associated with more referrals to non-VA care may affect other aspects of care that are valued by WVs, such as their relationship with their VA PC providers, coordination of care, and receipt of care from providers experienced in caring for Veteran-specific issues. [35][36][37] Our findings point to provider communication and gender sensitivity as essential drivers of how patients view their care.…”

Section: Discussionmentioning

confidence: 74%

“…While VA has sought greater oversight over the coordination of care between VA and community settings, how this coordination will be achieved and whether it will be tailored to WVs’ needs are still unknown. The increase in care fragmentation associated with more referrals to non‐VA care may affect other aspects of care that are valued by WVs, such as their relationship with their VA PC providers, coordination of care, and receipt of care from providers experienced in caring for Veteran‐specific issues …”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

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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“…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%

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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“…Approximately one-third of health care providers perceived that veterans chose community providers because of proximity and limited access to specialty care at VA facilities. A 2014 qualitative study of non-VA primary care providers' perspectives on care for rural veterans asked similar questions and found a slightly different pattern of results (Gaglioti et al, 2014). In that study, the top five reasons interviewed providers gave for rural veterans choosing community care were: having an established relationship (81. n this chapter, we examine the extent to which providers meet the seven components of readiness and the characteristics of providers that are most likely to do so.…”

Section: Chapter Fourmentioning

confidence: 98%

Ready or Not? Assessing the Capacity of New York State Health Care Providers to Meet the Needs of Veterans

Tanielian¹,

Farmer²,

Duffy³

et al. 2018

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This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest.RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND PrefaceVeterans represent a special population of men and women who have served their country, many facing extraordinary health risks during deployment. Because many veterans have served on overseas missions, including in combat, veterans with service-connected health issues are a clinically complex and potentially vulnerable population. The mission of the U.S. Department of Veterans Affairs (VA) health care system is to meet the health care needs of this population. Over the past decade, the demand for health care services among veterans has increased. In response, VA has increased both the number of health professionals working within its facilities and its purchases of care from private-sector providers to accommodate veterans whose needs cannot be met in-house. Thus, providers working in the civilian sector are an increasingly important part of the overall health workforce addressing veterans' needs. However, we know very little about whether private-sector health care providers are equipped to offer timely access to high-quality care that addresses the unique needs of veterans. As a result, many of the current training programs to sensitize private health care providers to these unique circumstances might not be targeting the areas or topics of greatest need.This study was designed to assess the capacity and readiness of health care professionals to address the service-connected health-related needs among veterans in New York State. This report describes the findings with respect to the training, experience, practices, and attitudes toward veterans and the VA health care system among licensed health care professionals across the state. The report should be of interest to policymakers and others interested in addressing concerns about veterans' access to high-quality care.

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Non-VA Primary Care Providers' Perspectives on Comanagement for Rural Veterans

Abstract: VA system barriers hinder communication between providers, possibly resulting in fragmented care. Addressing these barriers will potentially improve patient safety and satisfaction.

Cited by 38 publications

References 9 publications

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

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

Ready or Not? Assessing the Capacity of New York State Health Care Providers to Meet the Needs of Veterans

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