VA Fulfilled Veterans’ Timely Care Requests 86% of the Time and New Measure Offers Further improvements

January 29, 2021

Takeaway: An HSR&D study showed that VA fulfilled Veterans’ timely care requests 86% of the time across three years; however, an estimated 12% of timely care requests were not fulfilled, and such delays may drive patients outside VA. Using the timely care measure developed in this study may assist in identifying reasons underlying access variability – and inform strategies to bring greater consistency of timely care across clinics.

Timeliness, or the ability of a health system to provide care when requested, is a critical component of access and patient-centered care. To assess timeliness, measures need to include the length of time between the request for service, time it was provided, and the urgency of the request. Although timeliness is a goal of all healthcare systems, measures to assess it are limited. This retrospective study sought to leverage VA’s data infrastructure to generate an objective measure of the fulfillment of timely care requests, which could be tracked over time at multiple levels and adjusted for demographic, clinical, and geographic factors. Using VA data, investigators identified 1,467,566 timely care requests from 537,575 Veterans – instances when Veterans requested the next-available appointment or walked-in for care. They then sought to determine whether their new measure could assess the extent to which VA provided timely care (within 48 hours) through an outpatient or inpatient encounter or a secure message from a clinician. Findings show that:

• Across 160 VA primary care clinics, requests for timely care were fulfilled 86% of the time (range 83% to 88%). Of all timely care requests, 98% were fulfilled by VA, with 61-68% in primary care, followed by 26-31% in other VA clinics, and 3% in mental health clinics. Less than 1% of requests were fulfilled with secure messaging.
• Between 2014 and 2017, 32% to 39% of VA primary care patients requested timely care, with the number of patients making timely care requests increasing by 24%.

Impact

An estimated 12% of timely care requests were not fulfilled, and such delays may drive patients outside VA. Using this timely care measure may assist in identifying reasons underlying access variability – and inform strategies to bring greater consistency of timely care across clinics.

Batten A, Augustine M, Nelson K, and Kaboli P. Development of a novel metric of timely care access to primary care services. Health Services Research. April 2020;55(2):301-309.