Wyte T, and MacGregor C, Center for Implementation Practice and Research Support (CIPRS); Hunt SC, VA Puget Sound Healthcare System; Burgo L, VA Connecticut Healthcare System; Mittman BS, CIPRS;
Development of effective models for delivering integrated care remains a high priority for VHA. VHA’s Post-Deployment Integrated Care Initiative (PDICI) was launched in 2008 to improve quality of care for OEF/OIF Veterans via enhanced integration of mental health (MH), social work (SW), and other services with primary care (PC). In partnership with PDICI leadership, we sought to document coordination of care activities established for returning Veterans and to measure perceptions of sufficiency of coordination.
We conducted (1) a comparative case study assessment of post-deployment integrated care arrangements in a sample of 6 randomly selected VAMCs through interviews with key facility representatives, and (2) a national survey administered to a key stakeholder at each VA healthcare system (n = 111) to measure these arrangements and their perceived effectiveness.
Coordination of care activities were identified through our case studies and measured in the survey. We asked about activities between PC and SW, PC and MH, and MH and SW at initial evaluation and during ongoing care. Coordination of care activities were most prevalent between PC and SW (p <0.05). Case study data supported these findings. The perceived sufficiency of coordination of care was rated highest between PC and SW at 69% of facilities. In 65% of facilities, providers from at least two of the three service groups met formally to specifically discuss OEF/OIF Veteran care. 54% of respondents rated these meetings as “highly useful.” The data revealed that providers from different service groups, who previously had limited contact, felt more comfortable contacting each other for complex cases after having been “activated” by their experience in post-deployment coordination of care activities. A number of facilities indicated that their post-deployment activities were being used as a local model for implementing PACT.
The unique needs of the post-deployment population pose challenges to achieving effective integration of services. Recognizing these needs, the majority of facilities surveyed have established specific mechanisms to coordinate care between PC, MH, and SW. Social Work service appears to be playing a more central role for this population.
Increased understanding of evolving approaches to coordination of care is critical for improving care for complex patient populations.