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2019 HSR&D/QUERI National Conference Abstract

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4097 — Providing Same Day Access to Veterans: the VA Staff Perspective

Lead/Presenter: Sherry Ball,  Louis Stokes VAMC
All Authors: Ball SL (Louis Stokes Cleveland VAMC), Kenney, RR (Center of Innovation for Veteran Centered and Value Driven Care, Denver), Fehling, KB (Center of Innovation for Veteran Centered and Value Driven Care, Denver) Sayre, GG (Center of Innovation for Veteran Centered and Value Driven Care, Seattle; University of Washington Department of Health Services) Kirsh, SR (Office of Veteran Access to Care) Au, DH (Center of Innovation for Veteran Centered and Value Driven Care, Seattle; University of Washington Department of Medicine and Pharmacy) Ho, PM (Center of Innovation for Veteran Centered and Value Driven Care, Denver; University of Colorado Department of Medicine)

Objectives:
A set of declaration statements were released in 2016 outlining the commitment of the Veterans Administration (VA) to meeting primary, specialty and, mental health care needs of Veterans including offering same day access to care. The VA Collaborative Evaluation Center was tasked to complete an evaluation of efforts to implement these declaration statements across the VA. This report focuses on sites' experiences and unintended consequences, both positive and negative, related to the adoption, adaptation, and implementation of solution strategies to improve same day access to care.

Methods:
Qualitative data were collected from 81 interviews and 127 focus groups during 21 site visits. Sites were selected to obtain a balance of rural (7), urban (14), geographic and access metrics. Data were analyzed using deductive and inductive content analysis.

Results:
Staff at participating sites were knowledgeable regarding the VA policy to never turn away a Veteran requesting primary or mental health care. A few sites commented that Veterans have also become more aware of the availability of same day services and that knowledge, for some, meant they were more likely to seek needed care in a timely manner. While rural sites depended more on telehealth and non-VA care, all sites, regardless of location, noted unique challenges to providing timely care for Veterans living in rural areas such as providing or arranging for transportation and a greater need for coordinating multiple services in a single day.

Implications:
Sites consistently communicated a clear message to patients and staff regarding expectations for delivery of same day access to primary and mental health care. Distinct processes for triaging, coordinating, and referring patients was a key to success. Challenges were specifically noted for sites in rural areas and all sites serving Veterans living in rural areas.

Impacts:
The ability for VA sites to provide same day access to care can be facilitated by establishing clear practices for triaging and referring patients both within the VA and to non-VA providers. Communicating consistent terminology, expectations, and processes regarding same day access to both VA employees and patients can drive behavior of Veterans to seek care and staff to deliver care.