Examining Women Veteran’s Experiences, Perceptions, and Challenges With the Veterans Choice Program

Mattocks, Kristin M.; Yano, Elizabeth M.; Brown, Amber; Casares, José Ramón Gutiérrez; Bastian, Lori A.

doi:10.1097/mlr.0000000000000933

Cited by 33 publications

(37 citation statements)

References 7 publications

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“…While this may account for some part of the associations we observe in this study, prior research using the National Survey of Women Veterans supports a model in which care fragmentation leads to dissatisfaction, and identifies access and knowledge factors rather than patient experience as being the primary drivers for community care use . Recent qualitative studies on WVs’ experience obtaining care through the Veterans Choice Act are also consistent with an explanation of care fragmentation leading to dissatisfaction, and interviews with VA staff and providers lend further support to this explanation . We operationalized “lower care fragmentation” as receiving all care within VA (ie, no use of non‐VA care); other specifications of care fragmentation used in sensitivity analyses gave similar results.…”

Section: Discussionsupporting

confidence: 77%

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: Discussionsupporting

confidence: 77%

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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“…6 Additionally, studies of specific subgroups, such as women Veterans and Veterans with chronic hepatitis C virus, found that Veterans experienced difficulties in enrollment, ongoing support, and billing with third-party administrators, a lack of choice in location of treatment, and fragmented care that led to coordination challenges between VA and community providers. 7,8 Because ensuring access to healthcare for Veterans either within or outside of VA remains a priority of policymakers, it is important to understand who is seeking non-VA care and their experiences with that care. This study provides a unique perspective in that it used a mixedmethods design incorporating both quantitative and qualitative data.…”

Section: Introductionmentioning

confidence: 99%

Experiences with the Veterans’ Choice Program

et al. 2019

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BACKGROUND: To address concerns about Veterans' access to care at US Department of Veterans Affairs (VA) healthcare facilities, the Veterans Access, Choice, and Accountability Act was enacted to facilitate Veterans' access to care in non-VA settings, resulting in the "Veterans Choice Program" (VCP). OBJECTIVES: To assess the characteristics of Veterans who used or planned to use the VCP, reasons for using or planning to use the VCP, and experiences with the VCP. DESIGN: Mixed-methods. SUBJECTS: After sampling Veterans in the Midwest census region receiving care at VA healthcare facilities, we included 4521 Veterans in the analyses. Of these, 60 Veterans participated in semi-structured qualitative interviews. APPROACH: Quantitative data were derived from VA's administrative and clinical data and a survey of Veterans including Veteran characteristics and self-reported use of VCP. Associations between Veterans' characteristics and use or planned use of the VCP were assessed using logistic regression analysis. Interview data were analyzed using thematic analysis. KEY RESULTS: Veterans with a higher odds of reporting use or intended use of the VCP were women, lived further distances from VA facilities, or had worse health status than other Veterans (P ≤ 0.01). Key themes included positive experiences with the VCP (timeliness of care, location of care, access to services, scheduling improvements, and coverage of services), and negative experiences with the VCP (complicated scheduling processes, inconveniently located appointments, delays securing appointments, billing confusion, and communication breakdowns). DISCUSSION: Our findings suggest that Veterans value access to care close to their home and care that addresses the needs of women and Veterans with poor health status. The Mission Act was passed in June 2018 to restructure the VCP and consolidate community care into a single program, continuing VA's commitment to support access to community care into the future.

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“…Coordination problems related to making non-VA appointments, sharing electronic medical records between VA and non-VA systems, and timely receipt of results have all been well-documented. 2,3 Thus, the chief goals of coordination are to improve health outcomes by ensuring that care from a multitude of providers is not provided in silos, and to help reduce healthcare costs by eliminating waste from the system.…”

mentioning

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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Examining Women Veteran’s Experiences, Perceptions, and Challenges With the Veterans Choice Program

Cited by 33 publications

References 7 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

Experiences with the Veterans’ Choice Program

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

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