Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Director's Letter

Martin Charns, DBA , Acting Director of HSR&D

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

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