VA-Community Dual Care: Veteran and Clinician Perspectives

Schlosser, James; Kollisch, Donald O.; Johnson, Deborah J.; Perkins, Troi

doi:10.1007/s10900-020-00795-y

Cited by 27 publications

(52 citation statements)

References 33 publications

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“… 39 , 40 , 42 , 45 Study designs included: 14 observational articles, 31 , 33 , 35 , 36 , 38 – 47 and 2 descriptive articles. 34 , 37 While all articles examined the care coordination of rural Veterans, study participants varied: 7 included Veterans, 33 , 39 , 40 , 42 – 45 5 included VA providers, 34 , 36 , 40 , 46 , 47 and 8 included Community Care or other non-VA providers. 31 , 35 , 36 , 38 , 41 , 44 , 45 , 47 Study settings included: 6 National studies, 33 , 37 , 39 , 42 , 44 , 47 6 in Northern Plains states, 31 , 35 , 36 , 38 , 41 , 43 2 in Western states 34 , 46 and 2 in New England states.…”

Section: Resultsmentioning

confidence: 99%

“… 34 , 37 While all articles examined the care coordination of rural Veterans, study participants varied: 7 included Veterans, 33 , 39 , 40 , 42 – 45 5 included VA providers, 34 , 36 , 40 , 46 , 47 and 8 included Community Care or other non-VA providers. 31 , 35 , 36 , 38 , 41 , 44 , 45 , 47 Study settings included: 6 National studies, 33 , 37 , 39 , 42 , 44 , 47 6 in Northern Plains states, 31 , 35 , 36 , 38 , 41 , 43 2 in Western states 34 , 46 and 2 in New England states. 40 , 45 The Veteran health care focus of VA Community programs varied greatly: 3 on American Indian Community Care, 34 , 35 , 46 3 on sharing electronic health record (EHR) data, 31 , 44 , 47 2 on obstetrics and maternity, 39 , 42 1 on housing for the homeless, 36 1 on treatment for opioid use, 40 1 on retail immunization, 33 and 5 on interorganizational care coordination itself.…”

Section: Resultsmentioning

confidence: 99%

“…40 , 45 The Veteran health care focus of VA Community programs varied greatly: 3 on American Indian Community Care, 34 , 35 , 46 3 on sharing electronic health record (EHR) data, 31 , 44 , 47 2 on obstetrics and maternity, 39 , 42 1 on housing for the homeless, 36 1 on treatment for opioid use, 40 1 on retail immunization, 33 and 5 on interorganizational care coordination itself. 33 , 37 , 38 , 43 , 45 …”

Section: Resultsmentioning

confidence: 99%

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Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs

et al. 2021

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs

et al. 2021

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“…In many rural areas, lack of specialists in the community is a known barrier to care [ 31 ]. Among patients who did access community care for testing, lack of follow up and poor continuity of care was an important factor influencing preference for VA, previously identified as a factor influencing satisfaction with outsourced care among both patients and providers [ 32 , 33 ]. Our findings further reinforce the need to improve coordination between VA and the community to mitigate potential satisfaction and patient safety issues [ 3 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program

Nicosia

Kaul

Totten

et al. 2021

BMC Health Serv Res

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Background Obstructive sleep apnea is common among rural Veterans, however, access to diagnostic sleep testing, sleep specialists, and treatment devices is limited. To improve access to sleep care, the Veterans Health Administration (VA) implemented a national sleep telemedicine program. The TeleSleep program components included: 1) virtual clinical encounters; 2) home sleep apnea testing; and 3) web application for Veterans and providers to remotely monitor symptoms, sleep quality and use of positive airway pressure (PAP) therapy. This study aimed to identify factors impacting Veteran’s participation, satisfaction and experience with the TeleSleep program as part of a quality improvement initiative. Methods Semi-structured interview questions elicited patient perspectives and preferences regarding accessing and engaging with TeleSleep care. Rapid qualitative and matrix analysis methods for health services research were used to organize and describe the qualitative data. Results Thirty Veterans with obstructive sleep apnea (OSA) recruited from 6 VA telehealth “hubs” participated in interviews. Veterans reported positive experiences with sleep telemedicine, including improvements in sleep quality, other health conditions, and quality of life. Access to care improved as a result of decreased travel burden and ability of both clinicians and Veterans to remotely monitor and track personal sleep data. Overall experiences with telehealth technology were positive. Veterans indicated a strong preference for VA over non-VA community-based sleep care. Patient recommendations for change included improving scheduling, continuity and timeliness of communication, and the equipment refill process. Conclusions The VA TeleSleep program improved patient experiences across multiple aspects of care including a reduction in travel burden, increased access to clinicians and remote monitoring, and patient-reported health and quality of life outcomes, though some communication and continuity challenges remain. Implementing telehealth services may also improve the experiences of patients served by other subspecialties or healthcare systems.

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“…7,8 In addition, as we observed, the use of closer non-VHA care in times of emergency for new illnesses may encourage older veterans who value continuity to make and then maintain their specialty care with non-VHA providers. While the VHA has implemented enhanced coordination and continuity within the VHA system, the enhancement of VHA and non-VHA care coordination and communication needs improvement 45,46 and may help facilitate better care or return to the VHA. 14 The less frequently mentioned domains of availability, affordability, and accommodation are consistent with higher prioritization of continuity and thoroughness of care.…”

Section: Discussionmentioning

confidence: 99%

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

et al. 2021

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Background: Older veterans in urban settings rely less on the Veterans Health Administration (VHA) health care, suggesting deficits of access and services for aging veterans. We aimed to identify reasons for VHA and non-VHA use across the health status of older, urban-dwelling veterans.Methods: We examined open-ended responses from 177 veterans who were enrolled in primary care at the Bronx VA Medical Center, used non-VHA care in prior 2 years, and completed baseline interviews in a care coordination trial from March 2016 to August 2017. Using content analysis, we coded and categorized key terms and concepts into an established access framework. This framework included 5 categories: acceptability (relationship, second opinion), accessibility (distance, travel); affordability; availability (supply, specialty care); and accommodation (organization, wait-time). Selfreported health status was stratified by excellent/very good, good, and fair/poor.Results: We were able to categorize the responses of 166 veterans, who were older (≥75 years, 61%), minority race and ethnicity (77%), and low income (<$25,000/y, 51%). Veterans mentioned acceptability (42%) and accessibility (37%) the most, followed by affordability (33%), availability (25%), and accommodation (11%). With worse self-reported health status, accessibility intensified (excellent/very good, 24%; fair/poor, 46%; P = .031) particularly among minority veterans, while acceptability remained prominent (excellent/very good, 49%; fair/poor, 37%; P = .25). Other categories were mentioned less with no significant difference across health status.Conclusions: Even in an urban environment, proximity was a leading issue with worse health. Addressing urban accessibility and coordination for older, sicker veterans may enhance care for a growing vulnerable VHA population.

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VA-Community Dual Care: Veteran and Clinician Perspectives

Cited by 27 publications

References 33 publications

Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs

Interorganizational Care Coordination of Rural Veterans by Veterans Affairs and Community Care Programs

Leveraging Telehealth to improve access to care: a qualitative evaluation of Veterans’ experience with the VA TeleSleep program

Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

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