According to Former Secretary Shinseki, 3.3 million Veterans have difficulty accessing health care because they live far away from a Veterans Affairs (VA) medical facility. The problem is exacerbated for Veterans who need specialty care; specialty care is not typically available at community based outpatient clinics (CBOCs), forcing Veterans to rely on their primary care physician, seek a non-VA provider (e.g., through Fee Basis or Medicare) or travel to a tertiary VA facility. Preliminary evidence suggests that this can lead to delays in accessing care, and greater morbidity and mortality. To improve delivery of specialty care, VA operations needs to know more about when Veterans use VA specialty care, when they use Fee Basis care as a substitute, and how the mix of specialist and generalist care are associated with disease-specific quality of care and health outcomes. This project will provide a health services foundation that will inform policy makers and researchers about how to balance generalists and specialists. In this project, we will use observational methods to examine patterns of specialty care for Veterans diagnosed with one or more of the following complex conditions: congestive heart failure (CHF), hepatitis C (HCV), or epilepsy. These three conditions were selected because multiple medical, surgical, mental health and substance use specialists are likely to be needed for management. In addition, primary care providers have varied experience in managing these patients (epilepsy is low, HCV is moderate and CHF is higher). Finally, they present different treatment challenges: epilepsy is relapsing and remitting, CHF is a chronic condition, and HCV is a virus that can be treated. The implementation and dissemination of this work is enhanced with partnerships with three VA operational offices and two QUERI centers. We will stay connected with Operational offices with a technical advisory panel.
Limited access to specialty care is a major problem for over 3 million Veterans who live far away from a Veterans Affairs (VA) medical facility. These veterans can face significant delays in getting care that compromises their health and well being. In this project, we will examine how Veterans with congestive heart failure (CHF), Hepatitis C (HCV), or epilepsy are using specialty care, whether that is at the VA, purchased by VA or paid by Medicare. We will work with operational partners to investigate how Veterans are using specialty care and ways to improve access and outcomes. One of our key independent variables is wait time, which is a critical predictor for our operational partners.
| Wagner, Todd H; Subak, Leslee L (2010) Talking about incontinence: the first step toward prevention and treatment. JAMA 303:2184-5 |
