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2015 HSR&D/QUERI National Conference Abstract

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3189 — Vulnerability for Healthcare Communication Gaps for Users of VA Purchased Care: Implications for the Veterans Choice Act

Washington DL, VA Greater Los Angeles Healthcare System, VA GLA HSR&D Center of Innovation; University of California, Los Angeles School of Medicine; Hamilton AB, VA Greater Los Angeles Healthcare System, VA GLA HSR&D Center of Innovation; University of California, Los Angeles School of Medicine; Cordasco KM, VA Greater Los Angeles Healthcare System, VA GLA HSR&D Center of Innovation; University of California, Los Angeles School of Medicine;

Objectives:
The Veterans Choice Act is designed to expand timely access to health care for selected VA users through purchasing services from non-VA community providers. These care arrangements will potentially create coordination and communication gaps between patients' VA and non-VA providers, and between patients and their providers. Our objective was to identify patient characteristics associated with communication gaps among Veterans using VA-purchased non-VA care.

Methods:
We analyzed data from the National Survey of Women Veterans, a 2008-09 population-based telephone survey (response rate 86%). Our analytic sample was comprised of 604 participants who used any VA-purchased non-VA care in the 12 months prior. Perceptions of frequency of health care coordination and communication was measured with five questions, with responses of never, rarely, or some of the time indicating a communication gap. We assessed Veteran characteristics associated with communication gaps. All analyses applied design weights.

Results:
Forty-six percent of women Veterans perceived communication gaps in one or more measures. Frequencies were: VA medical providers knowing contract facility tests results (19%); knowing how to get contract facility test results (20%); good communication between VA and contract facility providers (23%); knowing who to call among VA and non-VA medical providers for problems with health (14%); getting an appointment for contract services at a convenient time (21%). Characteristics associated with perceived communication gaps were: age 18-44 years (65%), college education (54%), military service during Gulf War-to-present (59%), having service-connected disability (53%), and screening positive for a mood disorder (54%). In adjusted analysis, only younger age was associated with a perceived communication gap.

Implications:
A sizable proportion of women Veterans using VA purchased care reported communication gaps in their care.

Impacts:
The finding that younger Veterans are more likely to experience communication gaps is especially salient given that this is a growing demographic within VA-users. VA has recently implemented a new infrastructure to coordinate purchased care, though its effect on patient experiences of care is unknown. As the Veterans Choice Act is implemented nationally, the VA should continue to make efforts to ensure that care provided from multiple sources is coordinated and that communication between VA and non-VA providers is seamless.