Prior studies of others and our data demonstrate that a large proportion of Veterans access multiple systems for care. Veterans who use both VA and non-VA services are at increased risk of adverse events, especially during transitions of care when changes in medications and plan of care may occur without the knowledge of VA physicians. Lacking access to adequate information of non-VA care among Veterans may limit ability of VA providers to provide levels of care of a medical home. Given that little is known about how information exchange occurs in Veterans accessing dual care, it is difficult to prescribe solutions to bridge the gap of VA and non-VA care. Understanding how information exchange occurs, the current gaps and reasons behind these gaps, may allow for developing solutions that will help bridge VA and non-VA care. The objectives of the project are to better understand how information exchange between VA and non-VA settings currently occurs and to assess the quality of information exchange between VA and non-VA providers.
The specific aims of the study are (i) to describe how and to what extent information is exchanged with VA primary care teams among Veterans recently discharged from a non-VA hospital or emergency room; (ii) to determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process among these Veterans and (iii) to identify factors that are related to poor information exchange and with medical errors. The project will enroll Veterans from James J Peters VA Medical Center and Hudson Valley Health Care System, where up to 40% of Veterans have accessed non-VA care in the previous year. We will observe in a cohort of 200 Veterans in both urban and rural settings how information exchange occurs after a non-VA hospitalization or emergency room visit, and how and whether VA providers receive adequate information for ongoing care for Veterans. We will examine if the information exchange occurred according to VA dual care policy using a checklist derived directly from the dual care policy. We will then determine the incidence of medical errors, defined as medication errors, test follow-up errors and work up errors, during the care transition process from the review of documentation at the follow up visit at VA. We will then identify factors (Veteran, illness episode, and provider factors) that are associated with whether care was consistent with VA policy and with the incidence of medical errors.
Prior studies suggest that use of VA and non-VA system care may expose Veterans to increased risk of adverse outcomes. From the perspectives of VA providers, lacking access to adequate information of non-VA care among Veterans may limit ability of providers to provide high quality care with continuity to Veterans. Given the dearth of studies on how information exchange occurs in Veterans accessing dual care, it is difficult to prescribe solutions to bridge the gap of VA and non-VA care. The propose study will enhance our understanding of how information exchange occurs, the current gaps and reasons behind these gaps, and may allow for developing solutions that will help bridge VA and non-VA care.
