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VA Provider Perspectives on Coordinating COPD Care Across Health Systems

  • Seppo T. Rinne
  • Kirsten Resnick
  • Renda Soylemez Wiener
  • Steven R. Simon
  • A. Rani Elwy
Original Research

Abstract

Background

More and more Veterans are receiving care from community providers, increasing the need for effective coordination across health systems. For Veterans with chronic obstructive pulmonary disease (COPD), this need is intensified by complex comorbidity patterns that often include multiple providers co-managing patient care.

Objectives

We sought to understand how VA providers perceive coordination with community providers for Veterans with COPD.

Design

Qualitative study of VA providers.

Methods

We selected six geographically diverse VA sites and conducted semi-structured telephone interviews with providers practicing in inpatient and/or outpatient settings who care for Veterans with COPD.

Main Measures

Interviews focused on communication with community providers about discharge information and clinic management. We analyzed responses according to the principles of conventional content analysis, allowing inductive themes to emerge.

Key Results

We interviewed 25 providers during the period of June to October 2017. Qualitative data analysis yielded five themes: (1) VA providers perceive communication challenges between VA and community providers, including difficult, inadequate, and delayed communication; (2) communication is facilitated by personal relationships across health systems; (3) the lack of electronic health record (EHR) interoperability impairs communication, resulting in transmission of unstructured data; (4) poor communication leads to duplicative efforts and wasted resources; and (5) providers frequently rely on patients to communicate about care taking place in the community.

Conclusions

VA providers described major challenges in coordinating with community providers, leading to perceptions of delayed, missed, or duplicative care and jeopardizing the overall quality, safety, and efficiency of Veteran care. Our study highlights the need for system-level solutions to support coordination across health systems for Veterans with COPD and may have implications for other conditions that lead to recurrent hospitalization and/or care in the community.

KEY WORDS

coordination interdisciplinary communication qualitative research chronic obstructive pulmonary disease electronic health record 

Notes

Compliance with Ethical Standards

The project was approved by the Edith Nourse Rogers Memorial Veterans Hospital Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the US government.

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Copyright information

© Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2019

Authors and Affiliations

  • Seppo T. Rinne
    • 1
  • Kirsten Resnick
    • 1
  • Renda Soylemez Wiener
    • 1
  • Steven R. Simon
    • 1
  • A. Rani Elwy
    • 1
  1. 1.BedfordUSA

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