By Melinda Young
Focusing on better communication and care coordination, a Department of Veterans Affairs (VA) facility exhibited strength in its communication and care coordination, according to the authors of a new study.1
“There is a lot of focus on the VA self-coordinating care,” says Megan E. Vanneman, PhD, MPH, core investigator and career development award recipient with the Veterans Affairs Salt Lake City Informatics, Decision-Enhancement and Analytic Sciences Center. Vanneman also is an assistant professor in the division of health systems, innovation, and research in the department of population health sciences, and in the division of epidemiology in the department of internal medicine at the University of Utah School of Medicine.
In the VA, primary care is the hub for coordinated care, Vanneman explains. “Patients are assigned to a patient-aligned care team [PACT] to coordinate their services.”
PACT is part of the VA’s New Models of Care initiative, designed to transform care for veterans through providing a patient-driven, proactive, team-based, and personalized approach to wellness. (For more information, visit: https://www.patientcare.va.gov/primarycare/PACT.asp.)
The VA’s Office of Community Care’s coordination model uses triage to determine clinically indicated levels of care coordination. These range from basic to moderate to complex and to urgent care. “The VA uses the Care Assessment Needs [CAN] score that predicts hospitalization within the next year,” Vanneman explains. “It’s used as a model of care coordination.”
The CAN score, created in 2013 by the VA, looks at these factors:
- coexisting conditions;
- vital signs;
- use of services;
- pharmacy visits;
- lab results.
The CAN score helps providers in primary care, case management, and other services work together and accurately predict high-risk patients. (More information is available at: https://www.va.gov/HEALTHCAREEXCELLENCE/about/organization/examples/care-assessment-needs.asp.)
The study authors assessed veterans’ satisfaction when communicating with providers, asking them to rate communication questions from one to four, Vanneman says.
Communication questions included:
- Did the provider explain things in a way that you could understand?
- Did they listen to you?
- Did they show respect to what you had to say?
- Did they spend enough time with you?
In looking at the scores and controlling for factors like age, gender, physical health status, and perceived mental health status, the study found the differences in scores between how patients perceived the quality of services received in the VA vs. community providers to range from 2% to 15%, Vanneman says.
“The 2% was a provider rating on specialty care, and 15% was for primary care coordination,” she explains. “Basically, if there’s a 2% difference, you could ask if that’s clinically meaningful or a policy-relevant difference. That’s up to the eye of the beholder, but 15% is a substantial difference.”
The provider rating measure was from zero to 10 points. All baseline scores were better in the VA than in community care.1
The primary care group works hard to coordinate care. “It’s a complicated process, but everybody is doing their best to make sure veterans have coordinated care,” Vanneman adds.
The study authors found VA respondents were significantly different in sociodemographic characteristics from community care respondents. For instance, VA respondents were older, reported better perceived physical health and mental health status, were more likely to be men, had lower educational levels, and lived in more urban areas. VA respondents also were more likely to be married.1
The one factor that did not cause significantly different ratings between VA care and community care was access to care. “In this study, we found access to care was similar with the VA and community for primary care and mental health care,” Vanneman says. “The community scored better on specialty care, and specialty care improved in both over time.”
These are a few examples of the questions about access to care:
- Did you get the appointment when you needed it?
- Did you see the provider within 15 minutes of the appointment time?
- Did you receive an answer to your questions on the same day?
- Did you receive an answer to your medical questions as soon as you needed it?
“It was interesting to see the scores for access were similar for primary care providers and mental health, but the community did better on specialty care access,” Vanneman says.
- Vanneman ME, Wagner TH, Shwartz M, et al. Veterans’ experiences with outpatient care: Comparing the Veterans Affairs system with community-based care. Health Aff (Millwood) 2020;39:1368-1376.