Optimizing Veteran Decision-Making About Use of VA and Non-VA Health Care

背景：VA内外的主要医疗保健转型现在为退伍军人提供了 前所未有的医疗保健选择。在弗吉尼亚州，根据最近的联邦立法， 社区提供者和公众报告的访问和质量在VA设施的目标是扩大健康 为退伍军人提供护理选择，提高服务的及时性。在弗吉尼亚州之外，许多低收入的退伍军人 在扩大医疗补助的州，现在有了公共保险选择，而私人保险的退伍军人 越来越多的人在他们的健康计划中面临高额免赔额。 意义/影响：医疗保健融资和交付的重大转变为退伍军人提供了机会， 做出关于他们使用VA和非VA医疗保健的决定，以优化及时性，可负担性，质量， 和以病人为中心的关怀。然而，这些决定也带来了巨大的潜在意想不到的 如果他们不知情，后果会很严重。尽管如此高的风险，很少有人知道退伍军人是如何 做出关于使用VA和非VA护理的决定，他们想在这个决策中使用什么信息， 以及如何向退伍军人提供有关其医疗保健选择的信息。理解 这些问题对于国家努力扩大退伍军人医疗保健选择的成功至关重要。 退伍军人事务部使命法案，并实现一个退伍军人事务部医疗保健系统，是最大限度地响应退伍军人的需要。 创新：这项研究是第一次评估退伍军人的观点，经验和信息需求， 是VA医疗保健的用户和非用户。 具体目标：目标1：检查退伍军人如何做出关于VA和非VA护理的决定，以及 他们在做这些决定时想要使用的信息。目标2：确定退伍军人决策的相关因素， 使用VA和非VA医疗保健的使用和经验。目标3：让退伍军人和退伍军人管理局领导人参与进来， 确定机会，以优化退伍军人关于使用VA和非VA护理和VA的决策 对退伍军人医疗保健偏好的反应。 方法：我们将与退伍军人组织合作，进行焦点小组和半结构化 访谈，将审查决策经验的退伍军人谁使用VA护理，非VA护理，或两者兼而有之; 退伍军人在决策中使用过和希望使用的信息来源; VA和非VA护理的及时性、可负担性、质量和以患者为中心的经验。我们将 利用这些发现来制定和实地调查退伍军人的使用和决策有关VA 和非VA护理;与他们的决策和健康需求相关的因素;以及对及时性的看法， 负担能力、质量和以病人为中心的医疗保健。具有全国代表性的样本 3,000名退伍军人将包括VA医疗保健的用户和非用户。我们将识别退伍军人的特征 与VA和非VA医疗保健服务的使用及其VA和非VA医疗保健经验相关， 社区卫生保健机构。最后，我们将与退伍军人和退伍军人事务部进行审议论坛 领导人制定可用于支持退伍军人关于VA和非VA的决定的可行战略 保健使用审议和设计方法相结合，我们将分享前2个关键发现 目标，然后引导参与者通过一个协作过程，在这个过程中，他们将确定和优先考虑 计划和政策，可以支持退伍军人决策有关使用VA和非VA护理。 后续步骤/实施：产品将包括退伍军人使用的信息类型概要 以及对退伍军人事务部和非退伍军人事务部护理决策的需求，评估退伍军人决策的新调查措施 关于VA和非VA护理，以及可以实施以帮助 退伍军人决定VA和非VA护理。我们将使用这些产品与我们的VA和非- VA合作伙伴制定新的战略，以优化退伍军人关于VA和非VA护理的决策。

Background: Major health care transformations within and outside of VA are now providing Veterans with unprecedented health care choices. Within VA, under recent federal legislation integrated networks of community providers and public reporting of access and quality at VA facilities are aiming to expand health care choices for Veterans and improve the timeliness of services. Outside of VA, many lower-income Veterans in states that expanded Medicaid now have a public insurance option, while privately-insured Veterans are increasingly facing high deductibles in their health plans. Significance/Impact: Major shifts in health care financing and delivery present Veterans with opportunities to make decisions about their use of VA and non-VA health care that optimize the timeliness, affordability, quality, and patient-centeredness of their care. However, these decisions also carry great potential for unintended consequences if they are not well-informed. Despite such high stakes, little is known about how Veterans are making decisions about using VA and non-VA care, what information they want to use in this decision-making, and how provision of information to Veterans about their health care options could be improved. Understanding these issues is critical to the success of national efforts to expand health care choices for Veterans under the VA MISSION Act and to achieve a VA health care system that is maximally responsive to Veterans’ needs. Innovation: This study is the first to assess the views, experiences, and information needs of Veterans who are users and non-users of VA health care. Specific Aims: Aim 1: Examine how Veterans are making decisions about VA and non-VA care and what information they want to use when making these decisions. Aim 2: Identify correlates of Veterans’ decisions to use and experiences with using VA and non-VA health care. Aim 3: Engage Veterans and VA leaders to identify opportunities to optimize Veterans’ decisions about use of VA and non-VA care and VA’s responsiveness to Veterans’ health care preferences. Methodology: We will partner with Veterans organizations to conduct focus groups and semi-structured interviews that will examine decision-making experiences of Veterans who use VA care, non-VA care, or both; the sources of information Veterans have used and would want to use in this decision-making; and Veterans’ experiences with the timeliness, affordability, quality, and patient-centeredness of VA and non-VA care. We will use these findings to develop and field a national survey of Veterans’ use of and decision-making about VA and non-VA care; factors related to their decision-making and health needs; and perceptions of the timeliness, affordability, quality, and patient-centeredness of their health care. The nationally representative sample of 3,000 Veterans will include both users and non-users of VA health care. We will identify Veteran characteristics associated with use of VA and non-VA health care services and with their health care experiences in VA and community health care settings. Finally, we will conduct deliberative forums with Veterans and VA operational leaders to develop actionable strategies that can be used to support Veterans’ decisions about VA and non-VA health care. Using a combination of deliberation and design methods, we will share key findings from the first 2 Aims and then guide participants through a collaborative process in which they will identify and prioritize programs and policies that could support Veteran decision-making about use of VA and non-VA care. Next Steps/Implementation: Products will include a compendium of the types of information Veterans use and need for decision-making about VA and non-VA care, new survey measures to assess Veterans’ decisions about VA and non-VA care, and a prioritized list of programs and policies that could be implemented to help Veterans make decisions about VA and non-VA care. We will use these products to work with our VA and non- VA partners to develop new strategies to optimize Veteran decision-making about VA and non-VA care.