Developing a Patient-Centered Approach to Optimizing Veterans’ Access to Health Care Services Proceedings of a Workshop—in Brief (2020) / Chapter Skim
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Developing a Patient-Centered Approach to Optimizing Veterans' Access to Health Care Services: Proceedings of a Workshop - in Brief
Developing a Patient-Centered Approach to Optimizing Veterans' Access to Health Care Services: Proceedings of a Workshop - in Brief
Pages 1-9
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Department of Veterans Affairs' (VA's) Office of Veterans Access to Care, provided an overview of the Veterans Health Administration (VHA)
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Regarding delivery of care at the "right time," Yee said that it is important to implement flexible U.S. Department of Veterans Affairs Health Care System Structure Veteran Perceptions of Care Care Utilization Care Quality •Face-to-face Actual Access to Care Perceived Access to Care Patient-to-provider encounters •Technical •Geographical Provider-to-provider consults •Interpersonal Travel distance/time •Geographical Peer-to-peer support Travel burden •Digital •Temporal •Temporal Patient-to-provider Time constraints Provider-to-provider consults Time burden Waiting time Peer-to-peer support •Digital •Digital Use of computer applications Connectivity Connectivity gap Usability problems •Financial Eligibility •Financial Out-of-pocket costs Eligibility complexity Payment burden Care Satisfaction Care Outcomes •Cultural •Cultural •Utilization matches preferences •Symptoms Language match Understandability •Quality of care •Side effects Trust •Outcomes of care •Functioning •Quality of life •Cost Perceived Need for Care •Symptom burden Social Determinants of •Stoicism/self-reliance Access •Treatment efficacy •Self-efficacy FIGURE 1 Conceptualization of access within the VA health care system structure.
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Lillian Gelberg of the VA Greater Los Angeles Healthcare System noted that conceptualizing and measuring access are key to formulating health policy because of their potential to predict health care use; promote social justice; and improve patient outcomes, including health status (perceived and evaluated) , satisfaction with care, quality of life, and housing stability.
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Romano suggested measures that capture avoidable and unnecessary health care use, and Roland called for measuring continuity of care based on whether patients are able to access their preferred clinicians or services. Yee agreed that assessments of access should be responsive to patient needs, noting that sometimes the most appropriate care is a brief phone call and the traditional standard of scheduling an in-person appointment within 2 weeks would represent an unreasonable and unnecessary delay.
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Brian Skow of Avera Health described the company's work in telehealth, noting that the company works with underserved populations that include patients in rural health care settings, prisons, and the Indian Health Service. The company is in its third decade of virtual health delivery, spanning school services, behavioral health, and pharmacy services.
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Jeannette South-Paul of the University of Pittsburgh elaborated on care required for veteran populations, noting that VA has designated "special populations" that may require particular care, including minority veterans, veterans with substance use disorders, women veterans, veterans experiencing homelessness, veterans with spinal cord injuries or amputations, and veterans living in rural areas. Donna Washington of the VA Greater Los Angeles Healthcare System discussed how barriers to health care access contribute to health disparities.
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. • Deliver care through multiple modalities, including virtual care, to improve access and build trust be tween patients and clinicians (Campos, Chang, Choi, Heyworth, Lee, Overton, Skow)
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2020. Embedding social workers in Veterans Health Administration primary care teams reduces emergency department visits.
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Department of Veterans Affairs; Andrew Bindman, University of California, San Francisco; Joseph Kimura, Atrius Health; Timi Leslie, BluePath Health; Mark Murray, Mark Murray and Associates; Lisa Rubenstein, RAND Corporation and University of California, Los Angeles; Jeannette South-Paul, University of Pittsburgh School of Medicine; and Heather Young, University of California, Davis. REVIEWERS: To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop -- in Brief was reviewed by Adrian Atizado, Veteran Advocate, and Lillian Gelberg, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System.
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