Understanding Network Adequacy and Community Engagement in Veteran Care

为了回应关于退伍军人死亡和退伍军人获得护理的高度关注， 退伍军人健康管理局（VHA），国会颁布了退伍军人准入，选择和责任法案 （VACAA）在2014年建立退伍军人选择计划（VCP），并扩大社区的可用性 照顾合格的退伍军人。自成立以来，VCP已大幅增长，包括近五十万 使用VCP的退伍军人现在占VHA护理所有用户的17%。由于 由于VCP实施的时间较短，对其影响的研究有限，但突出了 社区提供商网络，以满足退伍军人的医疗保健需求。同时，退伍军人也没有 获得有关VCP提供商网络的信息，并且可能不确定哪些提供商 都是他们可以利用的。因此，需要进一步调查，以更好地了解退伍军人如何获得 关于社区护理的信息，以及这些信息如何告知他们寻求VA购买的决定 社区护理。这需要与定义、测量和评估网络的协同工作结合起来 非社区护理网络的安全性。这些措施合在一起，将确保 退伍军人经过仔细评估，制定了适当的标准，以满足他们的医疗保健需求。 寻求和需要非VA社区护理的退伍军人。 该项目将使用混合方法设计来识别医疗保健市场、医疗中心、第三方 支持或阻碍网络充分性的管理员和资深人员的特征和偏好， 因此，退伍军人获得护理的机会。我们将使用量化方法，利用标准化的国家数据 和流程结合定性方法，以说明各个VA医疗中心的情况， 退伍军人的偏好。采用这种设计，该项目将完成三个主要目标。的第一个目标 本研究旨在开发和验证非VA社区护理网络充分性的措施，并评估 VAMC和VA的98个市场之间网络充足性的区域差异。与此相关的是，该项目力求 检查社区护理决策在各个VA设施中做出的过程，并确定 现有和潜在的机会，扩大社区伙伴关系，以提供社区照顾。项目 还将采访退伍军人关于社区护理，包括对网络目录的偏好， 提供商和提供商的质量评级，以更全面地了解他们对社区的看法 在乎这些目标对VHA医疗保健和发展强大的 社区网络和VHA与周围社区供应商之间的联系， 为退伍军人提供医疗保健。因此，本研究团队和项目将解决VHA的一个重要优先事项， 从长远来看，改善在VHA接受护理的退伍军人的社区服务。

In response to highly publicized concerns regarding Veteran deaths and Veterans’ access to care in the Veterans Health Administration (VHA), Congress enacted the Veterans Access, Choice and Accountability Act (VACAA) in 2014 to establish the Veterans Choice Program (VCP) and expand the availability of community care for eligible Veterans. Since its inception, VCP has grown considerably, comprising nearly half a million providers, and Veterans using VCP now account for represents 17% of all users of VHA care. Due to the recency of VCP implementation, research on its impacts is limited but highlights issues with inadequacies of community provider networks to meet Veterans’ healthcare needs. Simultaneously, Veterans have also not been given access to information regarding VCP provider networks and can be uncertain of which providers are available to them. As a result, further investigation is needed to better understand how Veterans receive information regarding community care and how this information informs their decision to seek VA-purchased community care. This is required in conjunction with a concerted effort define, measure, and evaluate network adequacy for non-VA community care networks. Taken together, these steps will ensure that the needs of Veterans carefully assessed and appropriate standards are developed to meet the healthcare needs among Veterans seeking and requiring non-VA community care. This project will use a mixed methods design to identify healthcare market, medical center, Third Party Administrator, and Veteran characteristics and preferences that support or impede network adequacy and therefore, Veterans’ access to care. We will use quantitative methods to leverage standardized national data and processes combined with qualitative methods to account for individual VA medical center contexts and Veteran preferences. Using this design, the project will complete three main objectives. The first objective of this study is to develop and validate measures of network adequacy for non-VA community care and evaluate regional variations in network adequacy across VAMCs and VA’s 98 markets. Relatedly, the project seeks to examine the process by which Community Care decisions are made at individual VA facilities, and to identify existing and potential opportunities to expand community partnerships to deliver Community Care. The project will also interview Veterans regarding Community Care, including preferences for a network directory of providers and quality ratings of providers to more completely understand their perspectives on Community Care. These objectives have important implications for VHA healthcare and the development of strong community networks and connections between VHA and surrounding community providers to provide quality healthcare to Veterans. As a result, this study team and project will address an important priority with VHA and, in the long-term, improve community services for Veterans who receive care in the VHA.