Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans


In This Issue

Director's Letter

Director's Letter
by David Atkins, MD, MPH, Director, HSR&D

The crisis of the past year for VA over access will likely become an organizational case study about how not to use performance measures to drive system performance in a complex system...

Commentary

Listening to Veterans about Access to Care
by Steven M. Wright, PhD, VHA Office of Analytics and Business Intelligence, Washington, DC

Over-reliance on the structure of VA health care, such as wait time metrics, distracts us from measuring patient-perceived access from a broader conceptual foundation that includes geographical, temporal, financial, cultural, and digital dimensions. Some, but not all aspects of these access dimensions are addressed by the Survey of Healthcare Experience of Patients (SHEP), the single most important VA program to systematically assess patient perceptions of health care....

Response to Commentary

Tracking Veterans' Perceptions of Access to Care
by John Fortney, PhD, HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington; Susan Kirsh, MD, MPH, VA Office of Clinical Operations, Washington, DC; and Jeffrey Pyne, MD, HSR&D Center for Mental Healthcare and Outcomes Research and VA South Central Mental Illness Education and Clinical Center, Little Rock, Arkansas

Evidence clearly supports the need for a standardized program designed to improve timely access to outpatient care. To this end, VHA is currently embracing the use of an outpatient clinic practice management program...

Research Highlights

Distance and Access
by John F. McCarthy, PhD, MPH, Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Office of Mental Health Operations, HSR&D Center for Clinical Management Research, Ann Arbor, Michigan

The concept of access as "fit" can guide researchers to consider varied influences on treatment seeking and continuation behavior; the importance of client preferences and circumstances; the role of clinicians' perspectives and behaviors; and the impact of services organization and delivery practices...


Evaluation of Initiatives Designed to Increase Access to Patient Care: E-Consults and SCAN-ECHO
by Katherine Williams, MPH, and Leah Haverhals, MA with the VA Eastern Colorado Health Care System, Denver, Colorado and Sherry Ball, PhD, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio. The authors are affiliated with the Virtual VHA Specialty Care Evaluation Center.

Evaluation findings suggest initiatives such as SCAN-ECHO and E-Consults show much promise in improving access to care for Veterans. However, providing protected time for participating providers to be involved in these initiatives is critical for sustainability and success...


The Evolution of Veteran-Centric Access Metrics
by Julia Prentice, PhD, Steven Pizer, PhD, both with the Evidence-Based Policy Resource Center and Health Care Financing and Economics, VA Boston Healthcare System, Boston, Massachusetts

In 2014, VA underwent a widely publicized crisis in confidence as Congress and the public questioned whether appointment wait time metrics used by VA accurately reflected patient experience. Our work validating VA access metrics has found a consistent relationship between longer waits for VA care and decreased self-reported satisfaction. Our research findings also highlight the importance of using diverse metrics when assessing self-reported satisfaction for different populations...




Dialogue

Veteran Access to Health Care: A Conversation with VA Ann Arbor Healthcare System Director Robert McDivitt

FORUM Editors, Karen Bossi and Margaret Trinity, recently sat down with Robert McDivitt, Director of the VA Ann Arbor Healthcare System (VAAAHS) and Acting VISN 11 Network Director, to explore the topic of access—what access means in the context of the health care Veterans receive, as well as successes and challenges that VA Ann Arbor Healthcare System has experienced around access to care for Veterans ...