Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans (original) (raw)
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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.
BMC Health Services Research, 2018
Background Military Veterans in the United States are more likely than the general population to live in rural areas, and often have limited geographic access to Veterans Health Administration (VHA) facilities. In an effort to improve access for Veterans living far from VHA facilities, the recently-enacted Veterans Choice Act directed VHA to purchase care from non-VHA providers for Veterans who live more than 40 miles from the nearest VHA facility. To explore potential impacts of these reforms on Veterans and healthcare providers, we identified VHA-users who were eligible for purchased care based on distance to VHA facilities, and quantified the availability of various types of non-VHA healthcare providers in counties where these Veterans lived. Methods We combined 2013 administrative data on VHA-users with county-level data on rurality, non-VHA provider availability, population, household income, and population health status. Results Most (77.9%) of the 416,338 VHA-users who were e...
Accessing Services for Military Veterans through the Veterans Administration: Issues and Concerns
Military veterans will often utilize the Veterans Administration Hospital for multiple services such as medical, educational, or psychiatric assistance. Through this grounded-theory research study the focus was towards developing an understanding as to what services veterans are requesting and their satisfaction with services. Also addressed within this scope of research is their attitude towards obtaining private civilian care versus obtaining care through the Veterans Administration system, what issues they face and how they move through this government program. By developing an understanding, theories can emerge as to what services are most important to the veteran population, their accessibility to services and what improvements they would like to see occur within the Veterans Administration system to ensure military veterans needs are being addressed. Included is the priority ranking system that many veterans are familiar with, how this helps or hinders their ability to obtain services based on their ranking within the set criteria.
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 ...
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...
The future of Veterans Affairs Medical Centers
The Western journal of medicine, 1997
In the past four years, the Department of Veterans Affairs (VA) has experienced unprecedented changes in the ways it provides medical care, trains medical residents, and supports its clinical research program. For the most part, these changes have improved the quality and efficiency of care provided to veterans, and they have improved the chances that the VA will survive in an increasingly competitive medical market place. While the changes in priorities for training medical residents and funding clinical research have been designed to be more consistent with the overall mission of the VA, these changes have been stressful for many of the VA/medical school affiliations. Our challenge is to understand and manage these changes so that the many benefits that have derived from more than fifty years of VA/medical school affiliations can be retained.
Reinventing Veterans Health Administration: focus on primary care
Healthcare Quarterly, 2006
Can we improve access in primary care without compromising the quality of care? The purpose of this article is to demonstrate how timely access to primary care can be achieved without compromising the quality of the care being delivered. The Veterans Health Administration (VHA) is an integrated healthcare system that has implemented change to improve primary care access to the veterans it serves, while not only maintaining but also actually improving the quality of care. Many healthcare executives are struggling with achieving desirable access to care and continuity of care. To confront this problem, many large and small practices have initiated an approach known as advanced clinic access, open access, or same-day scheduling, introduced by the Institute for Healthcare Improvement (IHI). This approach has increasingly been used to reduce waits and delays in primary care without adding resources. To measure quality of care, specific performance measures were developed to quantify the effectiveness of primary care in VHA. Although it was initially viewed with concern and suspicion and was seen as a symptom of unnecessary micromanagement, healthcare team members were encouraged to use performance feedback as an opportunity for systems improvement as well as self-assessment and performance improvement for the team. All quality data are posted quarterly on VHA's internal website, providing visible accountability at all levels of the organization. Clinical workflow redesign leads to reduced wait times without
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