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2015 HSR&D/QUERI National Conference Abstract

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3034 — Perceptions of Patient-Centered Care in VAMCs and CBOCs

Malhiot AM, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Binns-Calvey AE, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Burkhart L, Marcella Niehoff School of Nursing; Loyola University Chicago; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Kostovich CT, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Marcella Niehoff School of Nursing, Loyola University Chicago; LaVela SL, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Feinberg School of Medicine, Northwestern University; Stroupe K, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Stritch School of Medicine, Loyola University Chicago; Gerber BS, Jesse Brown VA Medical Center; University of Illinois at Chicago; Weiner SJ, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Jesse Brown VA Medical Center; University of Illinois at Chicago; Weaver FM, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital; Stritch School of Medicine, Loyola University Chicago;

Objectives:
The ongoing transformation of care delivery in the Veterans Health Administration (VHA) emphasizes patient-centered care (PCC) and use of new care models that increase access to and choice for care delivery. Engaging patients in the assessment of VHA's transformation is essential; this can be accomplished using qualitative methods drawing from Veterans' own voices. The goal of this study is to assess patients' understanding of and preferences for PCC and examine similarities and differences between those who receive care at large urban VA medical centers (VAMCs) versus community-based outpatient clinics (CBOCs).

Methods:
Eight focus groups were conducted with patients receiving primary care from patient-aligned care teams at two Chicago-area VAMCs and four CBOCs (two rural, two suburban). Focus groups were audio recorded, transcribed verbatim, and analyzed by two independent coders using constant comparative techniques to code the data thematically.

Results:
Veteran participants (n = 49, including seven women) identified facilitators and barriers to receiving PCC. Common facilitators across facilities included: access and communication, positive patient/provider relationships, the sense of community associated with VA care, and use of technology. Access and communication issues were also the most commonly noted barriers to PCC, with differences between VAMCs and CBOCs. At CBOCs, access barriers included: limited urgent/emergency care, cost and distance of travel to larger facilities to see specialists, and problems with receiving prescriptions via mail. Veterans receiving care at CBOCs discussed technology (telehealth, secure messaging) as a means of overcoming access and communication barriers. VAMC barriers included: accessibility of primary care providers and wait times for appointments. Patients also perceived high physician turnover as a barrier at VAMCs; this was linked to Veterans' perceptions of VAMCs as "teaching hospitals."

Implications:
Access and communication with providers/PACT teams were both facilitators and barriers to PCC; Veterans' experiences were influenced by site of care (VAMC or CBOC). Positive patient/provider relationships, sense of community, and use of technology facilitate PCC.

Impacts:
Understanding Veterans' perceptions of PCC is crucial to the success of VHA's transformation. As recommended in the Blueprint for Excellence, direct patient engagement and gathering patient perspectives from Veterans should be incorporated in evaluation of all components of the VHA system.