Veteran Satisfaction with Early Experiences of Health Care Through the Veterans Choice Program: a Concurrent Mixed Methods Study

Jones, Audrey L.; Fine, Michael J.; Stone, Roslyn A.; Gao, Shasha; Hausmann, Leslie R. M.; Burkitt, Kelly H.; Taber, Peter; Switzer, Galen E.; Good, Chester B.; Vanneman, Megan E.; Zickmund, Susan

doi:10.1007/s11606-019-05116-1

Cited by 13 publications

(15 citation statements)

References 20 publications

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“…The domains of healthcare experience included: access, quality of care, perception of VA facilities, continuity of care, interactions with clinical and non-clinical staff (e.g., rude, doesn't listen), clinical and non-clinical staff demeanor (e.g., uncaring, stigmatizing), unresolved pain, costs of care, pharmacy services, and non-medical services (e.g., cafeteria, transportation) ( Table 1). As in our prior mixed methods research [12,23], we used data transformation to quantify the presence of domains in our sample. Specifically, we assigned binary values to indicate the presence (1) or absence (0) of a domain for each participant.…”

Section: Qualitative Domainsmentioning

confidence: 99%

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

et al. 2020

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Background Healthcare experiences associated with perceived racial/ethnic discrimination among patients are poorly understood. Objective Identify domains of patient dissatisfaction associated with perceived racial/ethnic discrimination among patients with pain. Design Semi-structured telephone surveys completed in 2013-2015. Participants White, African American, and Latino participants who reported receiving pain management from 25 Veterans Affairs (VA) Medical Centers. Main measures Surveys included open-ended questions about healthcare satisfaction/dissatisfaction and a measure of perceived racial/ethnic-based discrimination while seeking VA healthcare. Binary indicators for ten qualitative domains of dissatisfaction were derived from openended questions. We used multilevel models to identify dissatisfaction domains associated with perceived discrimination, adjusting for patient characteristics and site. Within domains associated with discrimination, we identified the most frequent codes and examined whether patients primarily referenced clinical or non-clinical staff in their experiences.

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Section: Qualitative Domainsmentioning

confidence: 99%

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

et al. 2020

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“…Prior studies found that the Veterans' Choice Program did not change Veterans' perceptions of access or availability of both VA-and non-VA care. 15,46,47 Additionally, studies suggest that expansion of Veteran access to non-VA care may be associated with higher rates of hospitalization, care duplication, and increased costs stemming from care fragmentation when Veterans utilize parallel systems of VA and community care. 48 Finally, the VA has a fixed budget for Veteran care; widespread utilization of non-VA primary care could rapidly deplete this budget, thereby reducing the capacity of VA services without improving the overall care that Veterans receive.…”

Section: Discussionmentioning

confidence: 99%

Mapping Rural and Urban Veterans’ Spatial Access to Primary Care Following the MISSION Act

et al. 2022

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The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. OBJECTIVE:Assess the extent to which the 2018 MIS-SION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. DESIGN:We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. PARTICIPANTS: American Community Survey data representing Oregon adults.MAIN MEASURES: Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand).KEY RESULTS: Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. CONCLUSIONS:Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.

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“…Previous studies have described extensive implementation problems with the Choice Act, including underdeveloped community provider networks, barriers to care coordination, problems with communication and scheduling, and Veteran dissatisfaction. [1][2][3][4][5] More recently, the Department of Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks (VA MISSION) Act of 2018 establishes a new permanent community care program, requiring VA to build a network of community providers through which Veterans can access care. The MISSION Act consolidates existing VA community care programs and provides more autonomy regarding utilization of community providers and more robust care coordination for Veterans using one consolidated program (the Community Care Network or CCN) instead of multiple programs.…”

Section: Introductionmentioning

confidence: 99%

“…Prior to VACAA, Veterans received a substantial majority of their care within the VA. VACAA allowed Veterans to receive care from non‐VA provider networks if the Veteran had to wait longer than 30 days for VA care or if the Veteran lived further than 40 miles from their closest VA medical facility with a full‐time primary care provider. Previous studies have described extensive implementation problems with the Choice Act, including underdeveloped community provider networks, barriers to care coordination, problems with communication and scheduling, and Veteran dissatisfaction 1‐5 …”

Section: Introductionmentioning

confidence: 99%

Developing network adequacy standards for VA Community Care

Mattocks

Elwy

Yano

et al. 2021

Health Services Research

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Objectives:To inform how the VA should develop and implement network adequacy standards, we convened an expert panel to discuss Community Care Network (CCN) adequacy and how VA might implement network adequacy standards for community care.Data Sources/Study setting: Data were generated from expert panel ratings and from an audio-recorded expert panel meeting conducted in Arlington, Virginia, in October 2017. Study Design:We used a modified Delphi panel process involving one round of expert panel ratings provided by nine experts in network adequacy standards. Expert panel members received a list of network adequacy standard measures used in commercial and government market and were provided a rating form listing a total of 11 measures and characteristics to rate.Data Collection Methods: Items on the rating form were individually discussed during an expert panel meeting between the nine expert panel members and VA Office of Community Care leaders. Attendees addressed discordant views and generated revised or new standards accordingly. Recorded audio data were transcribed to facilitate thematic analysis regarding opportunities and challenges with implementing network adequacy standards in VA Community Care.

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Veteran Satisfaction with Early Experiences of Health Care Through the Veterans Choice Program: a Concurrent Mixed Methods Study

Cited by 13 publications

References 20 publications

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

Mapping Rural and Urban Veterans’ Spatial Access to Primary Care Following the MISSION Act

Developing network adequacy standards for VA Community Care

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