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It has now been five years since the scandal of long waiting times and manipulated data broke at the Phoenix VAMC. Since then, VA has undertaken a variety of sweeping changes to try to improve access, including expanding community care options, instituting same-day access at all VAMCs, and expanding video telehealth into Veterans’ homes. These changes create a fertile environment for researchers to answer a series of critical questions: 1) has access actually improved and by how much? 2) what factors underlie the remaining access problems in VA and how can we address them? and 3) what role should community care play when Veterans can’t get timely or convenient access within VA?
Wait times in VA have improved—91 percent of appointments are scheduled within 30 days of the requested date. On the VA website created to help Veterans, average wait time for a new patient was under three weeks at the vast majority of VA facilities in Pennsylvania and although comparable wait time data are hard to get outside VA, one would be hard pressed to get in to see a new primary care provider in under three months in most cities. Despite these gains, VA still has plenty of work to do from the perspective of our Veterans. Based on the CAHPS Survey questions that ask whether they were able to receive needed care, only half of all Veterans say they could “always” get care as soon as they needed.
HSR&D needs to play a bigger role in helping VA with one of its most challenging problems. To date, much of our access portfolio has been focused on the important but narrow solution of telehealth. At a meeting last summer with leaders from the Office of Veterans Access to Care, three priority areas seemed the most promising for policy-relevant research: 1) improving metrics to track access, including wait times; 2) understanding relationships between wait times and patients’ satisfaction with access; and 3) improving productivity and reducing no-shows as a way to expand clinical capacity and access.
To improve our ability to inform VHA stakeholders concerned with access, which includes Rural Health, Primary Care, and Connected Care, HSR&D is establishing a Consortium of Research (CORE) on Access to build more effective partnerships, refine our research agenda, expand the pool of collaborating researchers, and communicate policy-relevant findings. We hope that this will address research’s own access challenge—providing our partners with access to the information they need when they need it so that they can apply effective solutions to better ensure that all Veterans can get the care they need when they need it.
David Atkins, MD, MPH, Director, HSR&D