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RRP 07-306 – HSR&D Study

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RRP 07-306
Multifaceted Assessment of Coordination of Care for OEF/OIF Veterans
Mary Jo V Pugh PhD EdM MA
South Texas Health Care System, San Antonio, TX
San Antonio, TX
Funding Period: August 2007 - February 2008

BACKGROUND/RATIONALE:
Recent events at Walter Reed Army Medical Center have highlighted issues which suggest that military members and veterans of the global war on terror may feel that they do not receive the medical care that they deserve given the profound sacrifices they have made for their country. While physical facilities have been at the center of this recent controversy, our discussions with clinicians caring for these patients suggest that they also experience issues with coordination of care in the transition from DoD to VA care. While it is clear that interventions may be needed to improve coordination of care and enhance the patients perceptions that they are well cared for, there is poor understanding of the appropriate target for intervention. This project examined perception of care provided to OEF-OIF veterans from the perspective of patient and provider to better understand concerns from a multifaceted perspective.

OBJECTIVE(S):
The primary aim of this study was to define the gaps in care coordination experienced by these patients so that future research can develop and implement interventions to improve the quality of care provided to these patients.

METHODS:
We conducted semi-structured individual interviews with veterans and VA frontline health care providers (primary care providers, clinic nurses, social workers, rehabilitation care providers). Interviews were digitally recorded and transcribed to VA encrypted server. Data were analysed by the research team using grounded theory methods.

FINDINGS/RESULTS:
Once coded, analysis suggested that themes found in our data were consistent with the organizational design framework, which posits that health care organizations are information-processing systems; the flow of information among participants is a function of the demands of the situation and the capabilities of the organization to move information where it is needed. The quality of care coordination and quality of care is thought to be associated with the fit between the need for information and the extent to which they receive that information. Results from provider interviews in particular indicate that there is a significant gap between their need for information and the information they receive. We believe multidisciplinary clinics for OEF-OIF veterans may bridge this gap.

IMPACT:
Despite substantial efforts by the Office of Seamless Transition to eliminate difficulties associated with the transition from DoD to VA care, rates of complaints related to coordination of care have increased 14% from FY03 to FY05 per the VHA Patient Advocate database. Problems in care coordination are related to quality of care provided and patient satisfaction. This project sought to better understand issues in care coordination from the perspective of veterans and frontline healthcare providers. This information will be used to inform future interventions to improve coordination of care for OEF-OIF veterans, and can be used as a foundation for improving care coordination for patients with chronic diseases.

PUBLICATIONS:
None at this time.


DRA: Military and Environmental Exposures, Health Systems
DRE: none
Keywords: Care Management, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none

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