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With the Veterans' Choice Act, VA is becoming a significant
purchaser of care in addition to its historical role as the largest
integrated healthcare delivery system in the United States.
This emerging role presents two challenges that researchers
can help to answer. First, how does VA ensure the quality and
value of the care that it purchases for Veterans? Second, how
does VA ensure coordinated care when Veterans are dual users of both VA and
community care?
Building on advances in the field of measurement and reporting of processes
and outcomes of care, VA researchers are developing new measures of quality
and value. VA researchers have made major scientific contributions toward
the measurement of quality of care, and can continue to advance this work
and help apply it to healthcare provided to Veterans in the community.
A key challenge, however, is the creation of a comprehensive integrated
database that contains the data needed for research, the development of
performance measures, and validation. Through collaboration with VA's Office
of Community Care, VA researchers can contribute to developing an information
system that will serve both clinical practice, involving community providers,
and research.
Coordination of care is the second challenge. Coordination can be considered in
several ways. At a minimum it is the exchange of information among providers
to facilitate informed decision-making and reduce unneeded, duplicative
diagnostic procedures. Coordination is challenging even within an integrated
delivery system using a common electronic health record. The fragmentation
of care that can result from dual use of VA and community providers presents
an even greater challenge. Several articles in this issue discuss the challenge
of information exchange. Initial research indicates that a systematized approach
to this information exchange contributes greatly to the coordination of care
for Veterans.
Beyond information exchange, coordination of care sometimes requires joint
decision-making between two or more providers. For example, many Veterans
receiving care in VA have a mental health diagnosis, and coordination of care is
often required between mental health and primary care providers. Facilitating
this coordination has been a major focus within VA, with placement of mental
health professionals in primary care locations and other initiatives. When such
consultations are needed, will VA and community providers know who each
other are and how to contact each other? Could an e-consult mechanism
facilitate this process?
Innovations, evaluation, and research are needed to address these new
challenges in an informed way.
Martin P. Charns, DBA
Co-Director, HSR&D Center for Healthcare Organization & Implementation Research
Acting Director, Health Services Research & Development Service |