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2019 HSR&D/QUERI National Conference Abstract

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1112 — The Role of Non-VA Care in Veterans' Experiences of Care Coordination

Lead/Presenter: Justin Benzer,  VISN 17 Center of Excellence, Waco TX
All Authors: Benzer JK (VISN 17 Center of Excellence, Waco, TX), Sara J. Singer (Stanford University School of Medicine and Graduate School of Business, Stanford, CA), Nathalie M. McIntosh (Massachusetts Health Quality Partners, Watertown, MA) David C. Mohr, PhD (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA) Varsha G. Vimalananda, MD, MPH (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center, Bedford MA) Martin P. Charns, DBA (Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA)

Prior literature suggests poor coordination between Department of Veterans Affairs (VA) and non-VA care may lead to poor quality. However, one prior study found that patients rated coordination higher when they had combined VA/non-VA care compared to non-VA only. The purpose of this study was to determine whether VA-only care was better coordinated than combined VA/non-VA care.

Patient perspectives of coordination were elicited between April and September 2016 through a national survey of 5,806 patients attributed to 262 primary care providers, from a national sample of 29 medical centers. VA administrative records were used to control for the effect of disease severity and comorbidities. Coordination was measured with the eight-dimension Patient Perceptions of Integrated Care survey. Non-VA care was measured through patient self-report.

Veterans who received VA/non-VA care reported significantly worse scores across all eight care coordination dimensions (i.e., higher knowledge fragmentation, lower knowledge integration, lower staff knowledge of medical treatment, lower support for self-directed care, lower treatment-related communication, lower communication of test results, lower information flow to specialists, and lower information flow related to hospital transitions) compared to Veterans who only received care in VA.

Building on prior research indicating that coordination is higher in combined VA/non-VA care compared to non-VA only, the pattern that emerges is that coordination is best within VA, moderate for combined VA/non-VA care, and worst in the private sector (although potentially equal or better within integrated systems). Future research should determine whether the decrease in quality for VA/non-VA care is due to a low capability for cross-system coordination in the private sector.

During this time of expanded VA patient access to private sector providers, this study emphasizes the need to invest in strategies to improve care coordination. The MISSION Act directs VA to establish standards for access and quality. However, there is uncertainty regarding how coordination will be prioritized given strong pressures to enhance access. This study highlights that coordination with non-VA providers should be a central component of quality standards under the Act.