VA Care Coordination Program Increased Primary Care Visits and Improved Transitional Care for Veterans Post Non-VA Hospital Discharge

Ayele, Roman; Liu, Wenhui; Rohs, Carly; McCreight, Marina; Mayberry, Ashlea; Sjoberg, Heidi; Kelley, Lynette; Glasgow, Russell E.; Rabin, Borsika; Battaglia, Catherine

doi:10.1177/1062860620946362

Cited by 3 publications

(2 citation statements)

References 25 publications

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“…23 Among veterans, a nurse-led transition of care intervention was demonstrated to increase follow-up visits in the 14 days after discharge from non-VHA hospitals. 24 This intervention included several components that would be expected to improve medication safety, such as telephone conversations with veterans about medication changes after hospital discharge and ensuring that the non-VHA discharge note, which likely contained an updated medication list, was sent to the veteran's primary care team at the VHA. Our data suggest that timely interventions, such as these, are needed on a larger scale for veterans after treatment for MI at non-VHA hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…The pharmacist-driven transition of care interventions, such as medication reconciliation, medication counseling, and postdischarge follow-up, have been shown to improve secondary prevention measures and decrease hospital reencounters after hospitalization for MI 23 . Among veterans, a nurse-led transition of care intervention was demonstrated to increase follow-up visits in the 14 days after discharge from non-VHA hospitals 24 . This intervention included several components that would be expected to improve medication safety, such as telephone conversations with veterans about medication changes after hospital discharge and ensuring that the non-VHA discharge note, which likely contained an updated medication list, was sent to the veteran’s primary care team at the VHA.…”

Section: Discussionmentioning

confidence: 99%

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Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals

Weeda,

Ward,

Gebregziabher

et al. 2023

Medical Care

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Introduction: Fragmentation of health care across systems can contribute to mistakes in prescribing and filling medications among patients treated for myocardial infarction (MI). We sought to compare omissions, duplications, and delays in outpatient medications used for secondary prevention among veterans treated for MI at Veterans Affairs (VA) versus non-VA hospitals. Methods: We utilized national VA and Centers for Medicare and Medicaid Services data (2012–2018) to identify veterans 65 years or older hospitalized for MI and measured the use of outpatient medications for secondary prevention in the 30 days after MI among those treated at VA versus non-VA hospitals. Results: A total of 118,456 veterans experiencing MI were included; of which 102,209 were hospitalized at non-VA hospitals. An omission in any medication class occurred more frequently among veterans treated at non-VA versus VA hospitals (82.8% vs 67.8%, P < 0.001). In multivariable modeling, the odds of omissions in any medication class were higher among those treated at non-VA versus VA hospitals (odds ratio: 3.04; 95% CI: 2.88–3.20). Duplications occurred more frequently in veterans treated at non-VA versus VA hospitals: 1.9% versus 1.6% had 1 or more for non-VA versus VA hospitals (P < 0.001). Veterans treated at non-VA hospitals were more likely to have delays of 3 days or more in prescription fills after hospital discharge (88.4% vs 70.6% across all classes, P < 0.001). Conclusions: Omissions, duplications, and delays in outpatient prescribing of secondary prevention medications were more common among 118,456 veterans treated at non-VA versus VA hospitals for MI. Interventions aimed at improving care transitions and optimizing medication use among veterans treated at non-VA hospitals should be implemented.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals

Weeda,

Ward,

Gebregziabher

et al. 2023

Medical Care

View full text Add to dashboard Cite

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Optimizing care coordination to address social determinants of health needs for dual-use veterans

Sjoberg

Liu

Rohs

et al. 2022

BMC Health Serv Res

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Background Veterans increasingly utilize both the Veteran’s Health Administration (VA) and non-VA hospitals (dual-users). Dual-users are at increased risk of fragmented care and adverse outcomes and often do not receive necessary follow-up care addressing social determinants of health (SDOH). We developed a Veteran-informed social worker-led Advanced Care Coordination (ACC) program to decrease fragmented care and provide longitudinal care coordination addressing SDOH for dual-users accessing non-VA emergency departments (EDs) in two communities. Methods ACC had four core components: 1. Notification from non-VA ED providers of Veterans’ ED visit; 2. ACC social worker completed a comprehensive assessment with the Veteran to identify SDOH needs; 3. Clinical intervention addressing SDOH up to 90 days post-ED discharge; and 4. Warm hand-off to Veteran’s VA primary care team. Data was documented in our program database. We performed propensity matching between a control group and ACC participants between 4/10/2018 – 4/1/2020 (N- = 161). A joint survival model using Markov Chain Monte Carlo technique was employed for 30-day outcomes. We performed Difference-In-Difference analyses on number of ED visits, admissions, and primary care physician (PCP) visits 120-day pre/post discharge. Results When compared to a matched control group ACC had significantly lower risk of 30-day ED visits (Hazard Ratio (HR) = 0.61, 95% Confidence Interval (CI) = (0.42, 0.92)) and a higher probability of PCP visits at 13–30 days post-ED visit (HR = 1.5, 95% CI = (1.01, 2.22)). Veterans enrolled in ACC were connected to VA PCP visits (50%), VA benefits (19%), home health care (10%), mental health and substance use treatment (7%), transportation (7%), financial assistance (5%), and homeless resources (2%). Conclusion We developed and implemented a program addressing dual-users’ SDOH needs post non-VA ED discharge. Social workers connected dual-users to needed follow-up care and resources which reduced fragmentation and adverse outcomes.

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Implementation of VA care coordination program to improve transitional care for veterans post-non-VA hospital discharge: an incremental cost analysis

Radcliff,

Ayele,

McCreight

et al. 2023

Implement Sci Commun

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Background The Veterans Affairs (VA) Healthcare System Community Hospital Transitions Program (CHTP) was implemented as a nurse-led intervention to reduce barriers that patients experience when transitioning from community hospitals to VA primary care settings. A previous analysis indicated that veterans who enrolled in CHTP received timely follow-up care and communications that improved care coordination, but did not examine cost implications for the VA. Methods A budget impact analysis used the VA (payer) perspective. CHTP implementation team members and study records identified key resources required to initially implement and run the CHTP. Statistical analysis of program participants and matched controls at two study sites was used to estimate incremental VA primary care costs per veteran. Using combined program implementation, operations, and healthcare cost estimates to guide key model assumptions, overall CHTP costs were estimated for a 5-year time horizon, including a discount rate of 3%, annual inflation of 2.5%, and a sensitivity analysis that considered two options for staffing the program at VA Medical Center (VAMC) sites. Results Implementation at two VAMCs required 3 months, including central program support and site-level onboarding, with costs of $34,094 (range: $25,355–$51,602), which included direct and indirect resource costs of personnel time, materials, space, and equipment. Subsequent annual costs to run the program at each site depended heavily on the staffing mix and caseload of veterans, with a baseline estimate of $193,802 to $264,868. Patients enrolled in CHTP had post-hospitalization VA primary care costs that were higher than matched controls. Over 5 years, CHTP sites staffed to serve 25–30 veterans per full-time equivalent transition team member per month had an estimated budget impact of $625 per veteran served if the transitional team included a medical social worker to support veterans with more social behavioral needs and less complex medical cases or $815 per veteran if nurses served all cases. Conclusions Evidence-based care coordination programs that support patients’ return to VA primary care after a community hospital stay are feasible to implement and run. Further, flexibility in staffing this type of program is increasingly relevant as the VA and other healthcare systems consider methods to reduce provider burnout, optimize staffing, reduce costs, and address other staffing challenges while improving patient care.

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VA Care Coordination Program Increased Primary Care Visits and Improved Transitional Care for Veterans Post Non-VA Hospital Discharge

Cited by 3 publications

References 25 publications

Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals

Medication Safety Events After Acute Myocardial Infarction Among Veterans Treated at VA Versus Non-VA Hospitals

Optimizing care coordination to address social determinants of health needs for dual-use veterans

Implementation of VA care coordination program to improve transitional care for veterans post-non-VA hospital discharge: an incremental cost analysis

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