Recent studies estimate that between 28 and 75% of veterans also receive care from non-VA providers. Dual use is a concern because splitting care between two or more health systems and multiple providers may result in poor coordination of services and a loss of continuity - ultimately putting the patient at increased risk of adverse outcomes. Most likely, one of the main reasons underlying the poor outcomes in dual users is poor care coordination. A recent strategy proposed to improve care coordination are Care Coordination Agreements which are written agreements articulating the responsibility for two or more providers. The overarching aim of the project described in this proposal is to develop best practice recommendations for dual use care for rural veterans which will be conveyed in the form of a White Paper completed by the conclusion of the 18-month study period. The White Paper will integrate both local and national research on 1) the scope and quality of information exchanged,2) the level of patient care coordination, 3) health benefit coordination between VA and Medicare, and 4) satisfaction between VA and non-VA health care teams. In addition, the White Paper will review results from a pilot study that explores care coordination agreements conducted as part of this proposal. The pilot study will be a randomized controlled trial of 60 veterans that compares usual care to an intervention which aims to improve care coordination for dual use rural veterans by educating them about the use of information technology to share health information and informing their providers about the extent and nature of care from other health care systems. The study will include an evaluation to determine the impact of this intervention on patient perceptions of integrated care coordination, provider perception of relational coordination, and the impact of the health information sharing as indicated by concordance of medication lists, and lower levels of medical duplication when compared with usual care. In the context of this trial, investigators will explore the acceptability and feasibility of co-managed care coordination agreements between VA and non-VA providers. Investigators propose to have an Executive Committee that would guide both the development of the White Paper and the pilot randomized controlled trial. Stakeholders from within the VA Office of Patient Care Services, the VA Office of Rural Health, the My HealtheVet Program Office and local administrators of VA fee-based care have agreed to participate. Non-VA stakeholders will also participate, including local primary care leadership and representatives from Iowa's Consumer Operated and Oriented Plans. The goal of the White Paper is to recommend ways to improve care for dual use veterans that is acceptable to providers, feasible within the current structure of VA health care, and likely to improve the value of care provided through federal health systems.
The overarching aim of the project described in this proposal is to develop best practice recommendations for dual use care for rural veterans which will be conveyed in the form of a White Paper completed by the conclusion of the 18-month study period. In addition, the proposal includes a pilot randomized controlled trial of 60 veterans which compares usual care to an intervention which aims to improve care coordination for dual use rural veterans by educating them about the use of information technology to share health information and informing their providers about the extent and nature of care from other health care systems. The goal of the pilot RCT and the White Paper is to recommend ways to improve care for dual use veterans that is acceptable to providers, feasible within the current structure of VA health care, and likely to improve the value of care provided through federal health systems.
