JGIM Supplement Features VA Research on Care Coordination Both within VA and with Non-VA Healthcare Providers
VA coordinates healthcare for Veterans within VA and with non-VA providers across a continuum of service intensity – from basic care coordination to highly resource-intensive case management (for Veterans with complex conditions). Coordinating care is essential for improving patients' clinical outcomes, enhancing patients' experiences of care, increasing provider satisfaction, and decreasing costs. In March 2018, a state-of-the-art (SOTA) conference on care coordination was jointly planned by VA HSR&D and the Offices of Primary Care, Community Care, Nursing Services, and Care Management and Social Work. The SOTA was organized into three workgroups: 1) measures and models of care coordination; 2) care coordination within the VA system; and 3) care coordination between VA and non-VA providers for care paid for by VA. SOTA participants included VA and non-VA health services researchers, clinicians, and policymakers. Funded by HSR&D, this JGIM Supplement presents recommendations from the SOTA, as well as original research papers on care coordination strategies within VA and between VA and non-VA providers.
Articles include, but are not limited to:
- Olmos-Ochoa and colleagues describe interviews with PACT clinical staff in five VA medical centers. Interviews revealed coordination-related resource barriers and challenges in aligning priorities across patients, staff, and leaders. These stakeholders recommended VA focus on staffing, training, clarifying roles and responsibilities, and launching care coordination initiatives.
- Mohr and colleagues found that VA primary care providers' assessments of relational coordination with specialists were correlated with patients' perceptions of how well their care was coordinated. This finding suggests that efforts to improve relational coordination between VA primary care providers (PCPs) and specialists would improve Veterans' experiences of care.
- Rinne and colleagues examined VA provider perspectives on the current state of coordination across care transitions for Veterans with chronic obstructive pulmonary disease (COPD) hospitalized in non-VA settings. Providers described experiencing major challenges, with delayed, missed, or duplicative care jeopardizing the overall quality, safety, and efficiency of Veteran care.
- Zulman and colleagues conducted a survey of VA patients who took part in a five-site demonstration of PACT Intensive Management (PIM). Veterans randomized to PIM were more likely to report having a VA healthcare provider who helps coordinate their care; that they were asked about their health goals; that they have a VA provider whom they trust and who respects them; and that their primary care satisfaction level was 10 on a 10-point scale. Findings suggest that the PIM model may hold promise for coordinating care for medically and socially-complex Veterans, although further investigations are needed to assess its impact on clinical outcomes.
- Benzer and colleagues examined how Veterans with mental health (MH) issues may have care coordination needs that differ from Veterans without MH issues. Among nearly 6,000 Veterans with diabetes completing an online survey, Veterans with mental health conditions reported significantly lower experiences with coordinated care compared to Veterans without MH conditions.
- Editorials include articles by: Cordasco and colleagues on how the integration of community care into healthcare for Veterans will impact research; Greenstone and colleagues on standardizing care coordination with VA from the perspective of the VHA Office of Community Care; and Gittell and Hajjar on a relational model of organizational change that will help support the relationships needed to effectively coordinate healthcare.
Care Coordination in the Veterans Health Administration. Journal of General Internal Medicine. May 2019;34(Issue 1 Suppl):1-98.