Appendix_1 – Supplemental material for MyVA Access: An Evaluation of Changes in Access for a System-Wide Program Implemented in the Veterans Health Administration (original) (raw)
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2006
The Veterans Health Study (VHS) had as its overarching goal the development, testing, and application of patient-centered assessments for monitoring patient outcomes in ambulatory care in large integrated care systems such as the Department of Veterans Affairs (VA). Unlike other previous studies, the VHS has capitalized on rich administrative databases restricted to the VA and linked to patient-centered outcomes. The VHS has developed a comprehensive set of general and disease-specific measures for use by systems of care for ambulatory patients. Chief among these assessments is the Veterans SF-36 Health Survey for measuring health-related quality of life in veteran ambulatory populations. The Veterans SF-36 Health Survey provides the cornerstone for this study and historically has been extensively disseminated and used in the VA with close to 2 million administrations nationally as part of its quality management system. National surveys administered by the VA since 1996 using the Veterans SF-36 Health Survey indicate important regional differences with implications for varying resource needs. Based upon the rich foundation provided by the VHS methodology, the VA has implemented some of these approaches as part of its quality monitoring system and can serve as a model for other large integrated systems of care.
Rand health quarterly, 2016
The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the Department of Veterans Affairs (VA) current and projected health care capabilities and resources. An examination of data from a variety of sources, along with a survey of VA medical facility leaders, revealed the breadth and depth of VA resources and capabilities: fiscal resources, workforce and human resources, physical infrastructure, interorganizational relationships, and information resources. The assessment identified barriers to the effective use of these resources and capabilities. Analysis of data on access to VA care and the quality of that care showed that almost all veterans live within 40 miles of a VA health facility, but fewer have access to VA specialty care....
VA Outreach Is an Essential Area for Improving Veterans’ Health Care Accessibility
Military Medicine
Introduction The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans’ health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans’ access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites’ efforts to improve VHA outreach and veterans’ experiences with access. Materials and Methods This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff (“VHA staff”) completed during 21 ...
Veterans??? Access to and Use of Medicare and Veterans Affairs Health Care
Medical Care, 2007
We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services. Methods: We used a retrospective, cross-sectional design to identify veterans who were eligible to use VA and Medicare health care in calendar year 1999. We analyzed national VA utilization and Medicare claims data. We used descriptive and multivariable generalized ordered logit analyses to examine how patient, geographic, and environmental factors affect the percent reliance on VA and Medicare inpatient and outpatient services. Results: Of the 1.47 million veterans in our study population with outpatient use, 18% were VA-only users, 36% were Medicare-only users, and 46% were both VA and Medicare users. Among veterans with inpatient use, 24% were VA only, 69% were Medicare only, and 6% were both VA and Medicare users. Multivariable analysis revealed that veterans who were black or had a higher VA priority were most likely to rely on the VA. Patient with higher risk scores were most likely to rely on a combination of VA and Medicare health care. Patients who lived farther from VA hospitals were less likely to rely on VA health care, particularly for inpatient care. Patients living in urban areas with more health care resources were less likely to rely on VA health care. Conclusions: VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care.
Comparison of Quality of Care in VA and Non-VA Settings
2010
HSR&D's Evidence-based Synthesis Program (ESP) was established to provide timely and accurate syntheses of targeted healthcare topics of particular importance to VA managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these reports throughout VA.
Military Health System Access to Care: Performance and Perceptions
Military Medicine, 2020
Introduction: Access to care (ATC) is an important component of providing quality healthcare. Clinics need to be able to accurately measure access; however, patients’ reports of access may be different from performance-based data gathered using administrative measures. The purpose of this research is to examine the relationship between ATC administrative data and patient survey results. Materials and Methods: This is a retrospective study performed in military medical treatment facilities. Survey data were obtained from the Joint Outpatient Experience Survey (JOES), and administrative data were collected from the Military Health System Data Repository. The data period was from May 2016 through March 2017 for 135 parent Military Treatment Facilities. This study was approved under the Defense Health Agency Internal Review Board (IRB number: CDO-15-2025). The analyses compare JOES ATC measures to administrative ATC measures. Overall correlation analyses and multivariate regression anal...
National VA Quality Improvement Survey: Preliminary Three Year Trends
PsycEXTRA Dataset
Since 1995, the Veterans Health Administration (VHA) has undertaken an extensive reorganization in an effort to improve the quality and efficiency of the delivery of health care. During this period 54 facilities have been integrated into multi-site healthcare systems, and some variant of service line structure has been implemented in primary care, mental health, or other clinical areas at more than 110 facilities. Staff and financial resources have been shifted from inpatient to outpatient care, exemplified by the opening of about 400 new Community-Based Outpatient Clinics. Perhaps most fundamentally, what had been a highly centralized organization was restructured into 22 geographic networks of facilities with considerable flexibility in determining how to reach national quality and performance goals. These changes in reporting relationships and budget authority were not ends unto themselves, but