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Takeaway: The VA Collaborative Evaluation Center (VACE), within HSR’s Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, conducts partnered research and evaluations of VA initiatives to assess effectiveness, barriers and facilitators, and unintended consequences. VACE’s recent collaboration with VA’s Office of Integrated Veterans Care (IVC) to evaluate VA’s Referral Coordination Initiative (RCI) informed IVC’s strategy for adapting its approach to RCI, with a shift to organize and standardize RCI processes at the regional (“VISN”) level, and engaging nurses in specialty care referral management.
The VA Collaborative Evaluation Center (VACE), within HSR’s Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, conducts partnered research and evaluations of the implementation of VA initiatives to assess effectiveness, barriers and facilitators, and unintended consequences. VACE works collaboratively with operational partners to ensure VACE’s evaluations are relevant and useful for program improvements and sustainability.
Beginning in 2022, investigators affiliated with the Denver and Seattle VACE sites collaborated with VA’s Office of Integrated Veterans Care (IVC) to evaluate VA’s Referral Coordination Initiative (RCI), which aims to streamline and improve the Veteran-centeredness of specialty care referrals, redistributing time-intensive referral triage tasks from specialist providers to nurses.
The objective of VACE’s evaluation, which was funded by IVC, was to assess VHA staff experiences with RCI as it was disseminated nationwide through facility-level organization and deployment. From May to December 2023, VACE investigators interviewed 68 front-line staff members in cardiology, gastroenterology, and pulmonary care at four VHA sites who were engaged in various aspects of specialty care referral coordination. Interviewees included nurses, schedulers, specialists, and providers.
VACE investigators found significant variation in RCI implementation, with heterogeneous processes related to specialty care referral coordination between and within VA medical centers. VACE’s evaluation identified key gaps and areas for improvement in the delivery of RCI, including:
Key facilitators of RCI that were identified by VACE included (1) leveraging existing relationships and nurses with specialty-specific expertise and (2) working with specialties to build relationships and create clear triage guidelines. Interviewees emphasized the importance of fostering collaboration with specialists to develop specialty-specific triage guidelines and receive ongoing training in triage.
VACE’s evaluation provided valuable insights that are likely to enhance Veterans’ access to care and care experiences by improving coordination and processes associated with specialty care referrals.
VACE found that while nurse-led triage can improve referral efficiency, concerted efforts are necessary to train nurses and develop triage criteria. The findings of VACE’s evaluation informed the IVC’s strategy to adapt its approach to RCI, with a shift to organize and standardize RCI at the regional (“VISN”) level starting in 2024 to establish consistent and harmonized processes between each VISN’s facilities. VACE findings also informed best practices in specialty care referral management that IVC has sought to replicate across the enterprise.
Office of Integrated Veterans Care
Office of Specialty Care
Read more about VACE’s evaluation of the RCI in an article published June 2025 in Health Services Research.
