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2019 HSR&D/QUERI National Conference Abstract

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1142 — Veterans' Experience of Health Care System Hassles: VA Care Only versus Dual Care

Lead/Presenter: Polly Noel,  Elizabeth Dole Center of Excellence for Veteran and Caregiver Research
All Authors: Noel PH ((Elizabeth Dole Center of Excellence on Veteran and Caregiver Research)), Barnard JM (Los Angeles COIN), Barry FM (Los Angeles COIN, University of California at Los Angeles) Simon A (Los Angeles COIN) Lee ML (Los Angeles COIN, University of California at Los Angeles) Olmos-Ochoa TT (Los Angeles COIN) Chawla N (Los Angeles COIN, University of California at Los Angeles) Rose DE (Los Angeles COIN) Stockdale SE (Los Angeles COIN) Finley EP (Elizabeth Dole COE on Veteran and Caregiver Research, Los Angeles COIN, & UT Health San Antonio) Penney LS (Elizabeth Dole COE on Veteran and Caregiver Research, UT Health San Antonio) Ganz DA (Los Angeles COIN, University of California at Los Angeles)

Objectives:
As the largest integrated health care system in the US, the VA faces unique challenges in coordinating care for Veteran enrollees, who bear a higher burden of illness than non-Veterans. With the MISSION Act's new community access standards, addressing expanding care coordination needs between VA and non-VA providers is critical to the VA's national priorities. To explore this issue, we compared health care problems or "hassles" experienced by Veterans who receive VA care only versus those who received both VA and non-VA care (dual care).

Methods:
As part of the Coordination Toolkit and Coaching project, we mailed baseline surveys to 5,095 randomly selected Veterans who had > = four visits in the prior year to one of 12 participating VA primary care clinics. We included the 16-item Health Care System Hassles Scale to assess Veterans' experience of health care hassles such as care coordination or communication problems. Our outcome was number of hassles reported as a "problem." We used zero-inflated negative binomial regression to examine the number of self-reported hassles, comparing Veterans who received VA care only versus dual care, adjusting for self-rated physical and mental health, sociodemographic characteristics, and clustering of Veterans within clinics.

Results:
Survey respondents (n = 2,444; 48%) were 85% male, 60% ? 65 years, 57% non-Hispanic White, 53% dual care users, and experienced a median of four hassles (interquartile range, 1-8). The most frequent hassles were waiting a long time to see specialists (50% VA only, 62% dual care), poor communication between health care providers (35% vs. 51%), and lack of information about which treatment options were best for Veterans' medical conditions (35% vs. 47%). Receipt of VA care only was independently associated with lower rates of self-reported hassles [adjusted incidence rate ratio = 0.86; 95% confidence interval = 0.80-0.94; p = 0.0002].

Implications:
Veterans who navigate both VA and non-VA systems of health care experience a significantly higher number of challenges than Veterans who use VA care only.

Impacts:
Given new access standards under the MISSION Act, frontline providers and leaders in primary care should plan for increased communication and coordination needs as dual care use increases.