Patients with complex healthcare concerns may receive care from a primary care physician, a visiting nurse, or a range of specialists. Coordinating that care can be challenging for patients and caregivers alike. Within VA, the goals of care coordination research are to understand those factors that contribute to effectively organized patient care and the sharing of information among all of a patient's caregivers. Ideally, care coordination research results in evidence that helps healthcare systems and providers achieve safer, higher quality, and more effective care for our nation's Veterans.
Each section below is populated by a dynamic search of the HSR&D website and its underlying databases. Search results are generated based on the search term "Care Coordination". Results are updated regularly, as new data are available.
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(5 of more than 159 CARE COORDINATION focused publications)
- Hynes DM, Govier DJ, Niederhausen M, Tuepker A, Laliberte AZ, McCready H, Hickok A, Rowneki M, Waller D, Cordasco KM, Singer SJ, McDonald KM, Slatore CG, Thomas KC, Maciejewski M, Battaglia C, Perla L. Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study. Frontiers in Health Services. 2023 Aug 15; 3:1211577.
- Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ open. 2023 May 17; 13(5):e060232.
- Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. International journal of care coordination. 2023 Jun 1; 26(2):55-61.
- Zullig LL, Lewinski AA, Woolson SL, White-Clark C, Miller C, Bosworth HB, Burleson SC, Garrett MP, Darling KL, Crowley MJ. Research-practice partnerships: Adapting a care coordination intervention for rural Veterans over 3 years at multiple sites. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2023 Jun 1; 39(3):575-581.
- Monty GR, Benson SK, Deeds SA, Callegari LS, Katon JG, Cordasco KM, Gray KE. "We Are Working Harder, Not Smarter:" a Qualitative Inquiry Into Care Coordination for Department of Veterans Affairs Mammograms Referred to the Community. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2022 Dec 15.
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(5 of more than 29 CARE COORDINATION focused publication briefs)
- Early Expansion of Benefits under Choice Act Increased Community Hospital Use but Did Not Change Mortality
This study examined changes in VA enrollees’ use of VA and non-VA hospitals from 2012-2017, as well as mortality associated with policies intended to increase access to care, such as the Choice Act. Findings showed that over the five-year study period, Veterans increased their use of community hospitals paid by VA and Medicaid and decreased their use of VA hospitals when access to non-VA care expa...
Date: June 10, 2022
- Challenges and Strain on VA System Associated with VA-Funded Community Care for Veterans with Advanced Kidney Disease
This study sought to further the understanding of the internal challenges of cross-system healthcare use to the VA healthcare system and enrolled Veterans. Three dominant themes pertaining to VA-financed community care were identified. Themes described VA as mothership, the hidden work of Veterans, and strain on the VA system. ‘VA as mothership’ describes extensive care coordination by VA staff me...
Date: May 16, 2022
- Genetic Consultation Provided by VA Facilities or Centralized VA Virtual Care More Timely and Better Coordinated than Community Care Options
This study assessed care coordination and equity in the delivery of genetic care for the care models available to VA patients (i.e., VA-traditional, centralized VA-telehealth, and non-VA care). Findings showed that VA genetic care models – both traditional and centralized telehealth – had better care coordination than non-VA care. Veterans referred to non-VA care completed their consult only 57% o...
Date: April 11, 2022
- Specialized Primary Care Homes Effective in Treatment of Patients with Serious Mental Illness
This project studied the implementation and effectiveness of a primary care medical home specifically designed to improve the healthcare of Veterans with serious mental illness. SMI PACTs (Patient Aligned Care Teams) include a specialized, integrated team that can provide both primary and psychiatric care. Findings showed that a primary care medical home for Veterans with SMI can be safe and more ...
Date: April 5, 2022
- For High-Risk Veterans, Fragmented Care from Multiple Providers Does Not Increase Risk of Hospitalization and May Lower Hospitalization for Ambulatory Care-Sensitive Conditions
This longitudinal study sought to examine outpatient care fragmentation and its association with future hospitalization among Veterans at high risk for hospitalization. Findings showed that among this cohort, fragmented outpatient care did not increase Veterans’ likelihood of future admission and, in fact, was associated with a lower likelihood of hospitalization for ambulatory care-sensitive cond...
Date: February 18, 2022
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( 5 of more than 32 CARE COORDINATION focused projects
|| Virtual Care Coordination in VA Primary Care-Mental Health Integration
|| Patient Experience of Specialty Care Coordination under the MISSION Act
|| Impacts of the Electronic Health Record Modernization on Women's Health Care Coordination: A Qualitative Investigation
|| Care Coordination and Outcomes for High Risk Patients: Building the Evidence for Implementation
|| Women Veteran''s Satisfaction with the Maternity Benefit, Maternity Care Coordination, and Barriers to Care
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HSR&D Briefs, Reports, Newsletters
5 sample "Care Coordination" publications displayed.
Overview: VA Telehealth || In Progress
The Anywhere to Anywhere VA Health Care Initiative, established in May 2018...access to at least a dozen virtual care sessions with VA providers. This bill...The Anywhere to Anywhere VA Health Care Initiative, established in May 2018...access to at least a dozen virtual care sessions with VA providers. This bill
Integrated Outpatient Palliative Care in Oncology
Integrated Outpatient Palliative Care in Oncology...Integrated Outpatient Palliative Care in Oncology 4 Prepared for: Department...4 Integrated Outpatient Palliative Care in Oncology http://www.hsrd.research
Care Coordination Models and Tools: A Systematic Review and Key Informant Interviews
...Care Coordination Models and Tools: A Systematic Review and Key Informant Interviews...Care Coordination Models and Tools: A Systematic Review and Key Informant Interviews...(ESP) Center Minneapolis VA Health Care System Minneapolis, MN Timothy J. Wilt
Advanced Wound Care Therapies for
Advanced Wound Care Therapies for Non-Healing Diabetic, Venous, and Arterial...Advanced Wound Care Therapies for Department of Veterans Affairs Health Services...Program November 2012 Advanced Wound Care Therapies for Non-Healing Diabetic,
Evaluating Care Coordination for Community Hospitalized Veterans || In Progress
...team approach to primary care through Patient Aligned Care Teams or PACTs, which...a primary care provider, clinical pharmacist, registered nurse care manager,...VA Primary Care » Table of Contents Evaluating Care Coordination for Community...enhance best practices for hospital care transitions, clarify the factors associated
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The most recent "Care Coordination" seminars are displayed.
Nursing State of the Art (SOTA) Conference: Research and Policy Recommendations
|| Sullivan, Sheila
Patient Care Assessment System (PCAS) 2022 Update
|| LaFontaine, Tom
Perioperative Buprenorphine Management
|| Hickey, Thomas
The Influence of Facilitation on Care Coordination in VA Primary Care: Evaluation of the CTAC Quality Improvement Project
|| Penney, Lauren
Tanya Olmos-Ochoa, Neetu Chawla
Survey Measures to Evaluate Specialty Care Coordination Within and Outside of VA
|| Vimalananda, Varsha
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