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Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care.
J Gen Intern Med. 2019 05; 34(Suppl 1):18-23.JG

Abstract

In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research & Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination.

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Authors+Show Affiliations

Mattocks KM
VA Central Western Massachusetts Healthcare System, Leeds, MA, USA. Kristin.Mattocks@va.gov. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA. Kristin.Mattocks@va.gov.
Cunningham K
VHA Office of Community Care, Washington, DC, USA.
Elwy AR
Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA. Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.
Finley EP
South Texas Veterans Health Care System, San Antonio, TX, USA. University of Texas Health Science Center, San Antonio, TX, USA.
Greenstone C
VHA Office of Community Care, Washington, DC, USA. University of Michigan Medical School, Ann Arbor, MI, USA.
Mengeling MA
The Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) and VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, IA, USA. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Pizer SD
VA Boston Healthcare System, Boston, MA, USA. Boston University School of Public Health, Boston, MA, USA.
Vanneman ME
Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA. Department of Internal Medicine/Division of Epidemiology & Department of Population Health Sciences/Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City, UT, USA.
Weiner M
VA Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA. Regenstrief Institute, Inc., Indianapolis, IN, USA. Center for Health Services and Outcomes Research, Indiana University, Indianapolis, IN, USA.
Bastian LA
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA. Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA.

MeSH

Continuity of Patient CareDelivery of Health Care, IntegratedHealth Services AccessibilityHumansQuality of Health CareUnited StatesUnited States Department of Veterans AffairsVeterans Health

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31098968

Citation

Mattocks, Kristin M., et al. "Recommendations for the Evaluation of Cross-System Care Coordination From the VA State-of-the-art Working Group On VA/Non-VA Care." Journal of General Internal Medicine, vol. 34, no. Suppl 1, 2019, pp. 18-23.
Mattocks KM, Cunningham K, Elwy AR, et al. Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care. J Gen Intern Med. 2019;34(Suppl 1):18-23.
Mattocks, K. M., Cunningham, K., Elwy, A. R., Finley, E. P., Greenstone, C., Mengeling, M. A., Pizer, S. D., Vanneman, M. E., Weiner, M., & Bastian, L. A. (2019). Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care. Journal of General Internal Medicine, 34(Suppl 1), 18-23. https://doi.org/10.1007/s11606-019-04972-1
Mattocks KM, et al. Recommendations for the Evaluation of Cross-System Care Coordination From the VA State-of-the-art Working Group On VA/Non-VA Care. J Gen Intern Med. 2019;34(Suppl 1):18-23. PubMed PMID: 31098968.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care. AU - Mattocks,Kristin M, AU - Cunningham,Kristin, AU - Elwy,A Rani, AU - Finley,Erin P, AU - Greenstone,Clinton, AU - Mengeling,Michelle A, AU - Pizer,Steven D, AU - Vanneman,Megan E, AU - Weiner,Michael, AU - Bastian,Lori A, PY - 2019/5/18/pubmed PY - 2020/10/7/medline PY - 2019/5/18/entrez KW - Veterans KW - care coordination KW - delivery of healthcare KW - health information interoperability SP - 18 EP - 23 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 34 IS - Suppl 1 N2 - In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research & Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination. SN - 1525-1497 UR - https://www.unboundmedicine.com/medline/citation/31098968/Recommendations_for_the_Evaluation_of_Cross_System_Care_Coordination_from_the_VA_State_of_the_art_Working_Group_on_VA/Non_VA_Care_ DB - PRIME DP - Unbound Medicine ER -