QUERI – Quality Enhancement Research Initiative

Examining VACAA Implementation and Care Coordination for Women Veterans

Northampton, MA

Overview:

Because women Veterans remain a numeric minority in the VA, there is wide facility-level variation in the availability of healthcare services for WVs, and many women must drive long distances to other VA facilities to receive the care they need. Under the Veterans Choice Act (VCA), eligible women Veterans will have more choice as to whether they seek community-based care or VA care. Understanding how VCA care is coordinated with ongoing VA care is of critical importance. Care received through the VCA will require significant coordination to ensure that women Veterans are receiving high-quality, non-fragmented comprehensive care. Examining the implementation of this care nationally for will serve as an important starting point for future care coordination interventions to facilitate and improve care coordination across VA facilities nationally for all non-VA care for all Veterans.

Objectives:

This qualitative evaluation project will use semi-structured interviews with key VA informants, including primary care and mental health providers, women's health providers, fee-basis managers, and women Veteran program managers), as well as non-VA key informants, such as non-VA-VCA providers. Project investigators also will:

• Conduct semi-structured interviews with women Veterans who received care through VCA; and
• Integrate their findings into actionable policy, practice, and further evaluation recommendations focused on improvements in care received through the VCA.

Methodology: We conducted site visits at 5 VA facilities nationally (Temple, TX; Helena, MT; Sheridan, WY; Fargo, ND; Sioux Falls, SD). At each facility, we interviewed numerous individuals familiar with women Veterans' experience with the Choice program, including the Choice Champion, Women Veteran Program Manager and Women's Health Medical Director, Chief of Mental Health, Chief of Primary Care, and the facility director, if possible. We also interviewed at least 10 women Veterans from each facility who had used the Choice program. With all participants, we focused on understanding what their perceptions and experiences with the Choice program had been, and what the barriers and facilitators to Choice program success might be. Early findings indicate that confusion regarding the Choice program among Veterans and VA staff, complicated scheduling procedures, insufficient women's health provider networks in the community, and lack of timely results sent back to the VA are hampering successful implementation of the Choice program.

Operations Partner: Women's Health, Women's Mental Health, OABI, QUERI

Principal Investigator: Kristin M. Mattocks, PhD, MPH; contact at Kristin.Mattocks@va.gov.