Skip to main content

Advertisement

SpringerLink
Log in

VA-Community Dual Care: Veteran and Clinician Perspectives

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Many veterans receive care in both community settings and the VA. Recent legislation has increased veteran access to community providers, raising concerns about safety and coordination. This project aimed to understand the benefits and challenges of dual care from the perceptions of both the Veterans their clinicians. We conducted surveys and focus groups of veterans who use both VA and community care in VT and NH. We also conducted a web-based survey and a focus group involving primary care clinicians from both settings. The main measures included (1) reasons that veterans seek care in both settings; (2) problems faced by veterans and clinicians; (3) association of health status and ease of managing care with sites of primary care; and (4) association of veteran rurality with dual care experiences. The primary reasons veterans reported for using both VA and community care were (1) for convenience, (2) to access needed services, and (3) to get a second opinion. Veterans reported that community and VA providers were informed about the others’ care more than half the time. Veterans in isolated rural towns reported better overall health and ease of managing their care. VA and community primary care clinicians reported encountering systems problems with dual-care including communicating medication changes, sharing lab and imaging results, communicating with specialists, sharing discharge summaries and managing medication renewals. Both Veterans and their primary clinicians report substantial system issues in coordinating care between the VA and the community, raising the potential for significant patient safety and Veteran satisfaction concerns.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Charlton, M. E., et al. (2016). Veteran use of health care systems in rural states: Comparing VA and non-VA health care use among privately insured veterans under age 65. The Journal of Rural Health,32(4), 407–417.

    Article  Google Scholar 

  2. Cordasco, K. M., Mengeling, M. A., Yano, E. M., & Washington, D. L. (2016). Health and health care access of rural women veterans: Findings from the National Survey of Women Veterans. The Journal of Rural Health,32(4), 397–406.

    Article  Google Scholar 

  3. West, A. N., & Charlton, M. E. (2016). Insured veterans’ use of VA and non-VA health care in a rural state. The Journal of Rural Health,32(4), 387–396.

    Article  Google Scholar 

  4. “Public Law 113 - 146 - Veterans Access, Choice, and Accountability Act of 2014 - Content Details - PLAW-113publ146. Retrieved December 20, 2019, from https://www.govinfo.gov/app/details/PLAW-113publ146.

  5. Sayre, G. G., Neely, E. L., Simons, C. E., Sulc, C. A., Au, D. H., & Ho, P. M. (2018). Accessing care through the veterans choice program: The veteran experience. Journal of General Internal Medicine,33(10), 1714–1720.

    Article  Google Scholar 

  6. Nevedal, A. L., Wagner, T. H., Ellerbe, L. S., Asch, S. M., & Koenig, C. J. (2019). A qualitative study of primary care providers’ experiences with the veterans choice program. Journal of General Internal Medicine,34(4), 598–603.

    Article  Google Scholar 

  7. VA MISSION ACT OF 2018 (VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act) Title I-Caring For Our Veterans Act of 2018 Subtitle A-Developing an Integrated High-Performing Network Chapter 1-Establishing Community Care Progra.

  8. Mattocks, K. M., Mengeling, M., Sadler, A., Baldor, R., & Bastian, L. (2017). The veterans choice act: A qualitative examination of rapid policy implementation in the department of veterans affairs. Medical Care,55, 1–5.

    Article  Google Scholar 

  9. Thorpe, J. M., et al. (2017). Dual health care system use and high-risk prescribing in patients with dementia: A national cohort study. Annals of Internal Medicine,166(3), 157–163.

    Article  Google Scholar 

  10. Meterko, M. (2017). Personal communication.

  11. Zucchero, T. L. C., McDannold, S., & McInnes, D. K. (2016). Walking in a maze’: Community providers’ difficulties coordinating health care for homeless patients. BMC Health Services Research,16(1), 480.

    Article  Google Scholar 

  12. Lampman, M. A., Mueller, K. J., & Lampman, M. (2011). Experiences of rural non-VA providers in treating dual care veterans and the development of electronic health information exchange networks between the two systems. The Journal of Rural Social Sciences,26(3), 201–219.

    Google Scholar 

  13. Nayar, P., Apenteng, B., Yu, F., Woodbridge, P., & Fetrick, A. (2013). Rural veterans’ perspectives of dual care. Journal of Community Health.,38(1), 70–77.

    Article  Google Scholar 

  14. Nayar, P., Nguyen, A. T., Ojha, D., Schmid, K. K., Apenteng, B., & Woodbridge, P. (2013). Transitions in dual care for veterans: Non-federal physician perspectives. Journal of Community Health,38(2), 225–237.

    Article  Google Scholar 

  15. Gaglioti, A., et al. (2014). Non-VA primary care providers’ perspectives on comanagement for rural veterans. Military Medicine,179(11), 1236–1243.

    Article  Google Scholar 

  16. Rinne, S. T., Resnick, K., Wiener, R. S., Simon, S. R., & Elwy, A. R. (2019). VA provider perspectives on coordinating COPD care across health systems. Journal of General Internal Medicine,34(S1), 37–42.

    Article  Google Scholar 

  17. Meyer, L. J., & Clancy, C. M. (2019). Care fragmentation and prescription opioids. Annals of Internal Medicine,170(7), 497.

    Article  Google Scholar 

  18. Zuchowski, J. L., et al. (2017). Coordinating care across health care systems for veterans with gynecologic malignancies: A qualitative analysis. Medical Care,55(7), S53–S60.

    Article  Google Scholar 

  19. Moyo, P., et al. (2019). Dual receipt of prescription opioids from the department of veterans affairs and medicare part D and prescription opioid overdose death among veterans. Annals of Internal Medicine,170(7), 433–442.

    Article  Google Scholar 

  20. Gellad, W. F., Zhao, X., Thorpe, C. T., Mor, M. K., Good, C. B., & Fine, M. J. (2015). Dual use of department of veterans affairs and medicare benefits and use of test strips in veterans with type 2 diabetes mellitus. JAMA Internal Medicine,175(1), 26–34.

    Article  Google Scholar 

  21. Wolinsky, F. D., Miller, T. R., An, H., Brezinski, P. R., Vaughn, T. E., & Rosenthal, G. E. (2006). Dual use of medicare and the veterans health administration: Are there adverse health outcomes? BMC Health Services Research,6(1), 131.

    Article  Google Scholar 

  22. Rinne, S. T., Elwy, A. R., Bastian, L. A., Wong, E. S., Wiener, R. S., & Liu, C. F. (2017). Impact of multisystem health care on readmission and follow-up among veterans hospitalized for chronic obstructive pulmonary disease. Medical Care,55(7), 20–25.

    Article  Google Scholar 

  23. Benzer, J. K., et al. (2019). Survey of patient-centered coordination of care for diabetes with cardiovascular and mental health comorbidities in the department of veterans affairs. Journal of General Internal Medicine,34(S1), 43–49.

    Article  Google Scholar 

  24. McHorney, C. A., Ware, J. E., Rogers, W., Raczek, A. E., & Lu, J. R. (1992). The validity and relative precision of MOS short- and long- form health status scales and Dartmouth COOP charts: Results from the medical outcomes study. Medical Care,30(5), 253–265.

    Google Scholar 

  25. Friedberg, M. W., et al. (2019). Development and psychometric analysis of the revised patient perceptions of integrated care survey. Medical Care Research and Review. https://doi.org/10.1177/1077558719842951.

    Article  PubMed  Google Scholar 

  26. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics,42(2), 377–381.

    Article  Google Scholar 

  27. United States Department of Agriculture. (2019) Rural-urban commuting area codes. Retrieved February 8, 2019, from https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/.

  28. Cordasco, K. M., et al. (2019). Coordinating care across VA providers and settings: Policy and research recommendations from VA’s state of the art conference. Journal of General Internal Medicine,34(S1), 11–17.

    Article  Google Scholar 

  29. Cordasco, K. M., Hynes, D. M., Mattocks, K. M., Bastian, L. A., Bosworth, H. B., & Atkins, D. (2019). Improving care coordination for veterans within VA and across healthcare systems. Journal of General Internal Medicine,34(S1), 1–3.

    Article  Google Scholar 

  30. Peterson, K., et al. (2019). Health care coordination theoretical frameworks: A systematic scoping review to increase their understanding and use in practice. Journal of General Internal Medicine,34(S1), 90–98.

    Article  Google Scholar 

  31. McDonald, K. M., et al. (2019). Incorporating theory into practice: Reconceptualizing exemplary care coordination initiatives from the US veterans health delivery system. Journal of General Internal Medicine,34(S1), 24–29.

    Article  Google Scholar 

  32. Singer, S. J., Kerrissey, M., Friedberg, M., & Phillips, R. (2018). A comprehensive theory of integration Medical care research and review. Thousand Oaks: SAGE Publications.

    Google Scholar 

  33. VHA Office of Reporting Analytics Performance Improvement & Deployment, Attributable Effects Analysis of Community Care--January 2017, (2017).

  34. Tsai, J., et al. (2017). ‘Where’s my choice?’ An examination of veteran and provider experiences with hepatitis C treatment through the veteran affairs choice program. Medical Care,55(7), 13–19.

    Article  Google Scholar 

  35. Anhang, P. R., Sloss, E. M., Cefalu, M., Farmer, C. M., & Hussey, P. S. (2018). Comparing quality of care in veterans affairs and non-veterans affairs settings. Journal of General Internal Medicine,33(10), 1631–1638.

    Article  Google Scholar 

  36. O’Hanlon, C., et al. (2016). Comparing VA and non-VA quality of care: A systematic review. Journal of General Internal Medicine,32(1), 105–121.

    Article  Google Scholar 

  37. Blay, E., DeLancey, J. O., Hewitt, D. B., Chung, J. W., & Bilimoria, K. Y. (2017). Initial public reporting of quality at veterans affairs vs non–veterans affairs hospitals. JAMA Internal Medicine,177(6), 882.

    Article  Google Scholar 

  38. Weeks, W. B., & West, A. N. (2018). Veterans health administration hospitals outperform non–veterans health administration hospitals in most health care markets. Annals of Internal Medicine,170(6), 426–428.

    Article  Google Scholar 

  39. VA HEALTH CARE Estimating Resources Needed to Provide Community Care Report to Congressional Requesters United States Government Accountability Office. (2019).

  40. Kupfer, J., Witmer, R. S., & Do, V. (2018). Caring for those who serve: Potential implications of the veterans affairs maintaining internal systems and strengthening integrated outside networks act of 2018. Annals of Internal Medicine,169(7), 487.

    Article  Google Scholar 

  41. Fryer, A. K., Friedberg, M. W., Thompson, R. W., & Singer, S. J. (2017). Patient perceptions of integrated care and their relationship to utilization of emergency, inpatient and outpatient services. Healthcare,5(4), 183–193.

    Article  Google Scholar 

  42. Mohr, D. C., et al. (2019). Organizational coordination and patient experiences of specialty care integration. Journal of General Internal Medicine,34(S1), 30–36.

    Article  Google Scholar 

Download references

Funding

Research reported in this publication was supported by The Dartmouth Clinical and Translational Science Institute, under Award Number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and the Manchester VA Medical Center.

Author information

Authors and Affiliations

  1. VA New England Healthcare System, the Manchester VA Medical Center, Manchester, USA

    James Schlosser

  2. VA New England Healthcare System, the White River Junction VA Medical Center, White River Junction, USA

    Donald Kollisch

  3. Geisel School of Medicine At Dartmouth, Hanover, USA

    Donald Kollisch, Deborah Johnson & Ardis Olson

  4. Nicholas School of the Environment, Duke University, Durham, USA

    Troi Perkins

  5. Concord, USA

    James Schlosser

Authors
  1. James Schlosser
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald Kollisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Troi Perkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ardis Olson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization—JS, DK; methodology—JS, DK, DJ, AO; formal analysis—JS, DK, AO, DJ, TP; writing—original draft preparation, JS, DK; writing—review and editing, JS, DK, DJ, TP, AO; project administration, DJ, TP, JS; funding acquisition, JS.

Corresponding author

Correspondence to James Schlosser.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the NIH, the Geisel School of Medicine at Dartmouth, the Department of Veterans Affairs or the United States Government.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schlosser, J., Kollisch, D., Johnson, D. et al. VA-Community Dual Care: Veteran and Clinician Perspectives. J Community Health 45, 795–802 (2020). https://doi.org/10.1007/s10900-020-00795-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-020-00795-y

Keywords

Search

Navigation