Barriers and Facilitators to Veterans Administration Collaboration With Community Providers: The Lodge Project for Homeless Veterans

Abstract

Since 2009, the U.S. Veterans Administration has made concentrated efforts to end homelessness among veterans. As part of these efforts, the Iowa City, Iowa, VA Health Care System in collaboration with local community providers deployed a supportive housing program aimed at homeless veterans. Called the Lodge program, it is intended to serve a Mid-Western mid-size city and its surrounding rural communities. This article presents qualitative findings from a mixed-method, two-year formative evaluation of the Lodge's implementation. Primary barriers to the effectiveness of the Lodge program were regulations hindering cooperation between service programs, followed by problems regarding information sharing and client substance abuse. Facilitators included personal communication and cooperation between individuals within and among service groups. The feasibility of implementing a Lodge program in a more rural community than Iowa City was also discussed.

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

“…33 , 41 , 47 One article each addressed health quality 38 and quality of life. 36 On the basis of the initiative effectiveness concluded by the authors of each article, there was no pattern of initiative outcomes improvement over the decade of Pre-Choice (2009–2013), Choice Era (2014–2017), and MISSION Era (2018–2020) initiatives.…”

“… 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.…”

“…Of these, 6 articles praised VA, particularly primary care providers, noting that communication improves when tailored to the needs of the care setting. 31 , 36 , 41 , 42 , 45 , 47 Seven articles cited both VA and Community Care for problematic communication and information sharing, such as: lack of contact information, reliance on Veterans to convey health records between systems, 41 and delayed response to requests. 31 , 37 , 38 , 41 , 43 , 44 One community provider remarked: “information-wise it’s a black hole in space.” 45 …”

“…In an article about a shelter for formerly homeless Veterans, shared goals and knowledge of VA and community partner capabilities set positive expectations, which program administrators then successfully met through informal, personal communication and cooperation. 36 …”

“…Third, for care coordination to prosper, organizational mechanisms between clinical operations must be well-tuned. Both partners can aim to provide adequate staffing and sufficient training for providers, 40 , 47 patients, 42 and TPAs 37 , 39 ; establish shared goals 33 ; clear roles and performance standards 31 , 34 , 41 ; and provide accessible contact points for patients and providers, 43 while strengthening interpersonal communication, 36 , 41 particularly with specialists. 31 In terms of IT, organizations advance when basic IT infrastructure is in place, 35 , 44 , 46 with the long-term goal of interoperability with partner systems and connection to others via HIEs for accurate, efficient EHR access.…”