Access to Specialty Care for Veterans with Complex Conditions

 描述（由申请人提供）： 据前部长Shinseki说，330万退伍军人很难获得医疗保健，因为他们住在远离退伍军人事务部（VA）的医疗设施。对于需要专科护理的退伍军人来说，这个问题更加严重;社区门诊诊所（CBOC）通常无法提供专科护理，迫使退伍军人依赖他们的初级保健医生，寻求非VA提供者（例如，通过收费基础或医疗保险）或前往三级VA设施。初步证据表明，这可能导致获得护理的延误，以及发病率和死亡率的上升。 为了改善专业护理的提供，VA运营需要更多地了解退伍军人何时使用VA专业护理，何时使用收费基础护理作为替代品，以及专家和通才护理的组合如何与特定疾病的护理质量和健康结果相关。该项目将提供一个卫生服务基础，告知决策者和研究人员如何平衡通才和专家。 在本项目中，我们将使用观察方法来检查被诊断患有以下一种或多种复杂疾病的退伍军人的专业护理模式：充血性心力衰竭（CHF）、丙型肝炎（HCV）或癫痫。之所以选择这三种情况，是因为可能需要多名内科、外科、心理健康和药物使用专家进行管理。此外，初级保健提供者在管理这些患者方面有不同的经验（癫痫较低，HCV中度，CHF较高）。最后，他们提出了不同的治疗挑战：癫痫是复发和缓解，CHF是一种慢性疾病，HCV是一种可以治疗的病毒。通过与退伍军人事务部的三个业务办事处和两个QUERI中心建立伙伴关系，加强了这项工作的实施和传播。我们将通过技术咨询小组与运营办公室保持联系。

 DESCRIPTION (provided by applicant): According to Former Secretary Shinseki, 3.3 million Veterans have difficulty accessing health care because they live far away from a Veterans Affairs (VA) medical facility. The problem is exacerbated for Veterans who need specialty care; specialty care is not typically available at community based outpatient clinics (CBOCs), forcing Veterans to rely on their primary care physician, seek a non-VA provider (e.g., through Fee Basis or Medicare) or travel to a tertiary VA facility. Preliminary evidence suggests that this can lead to delays in accessing care, and greater morbidity and mortality. To improve delivery of specialty care, VA operations needs to know more about when Veterans use VA specialty care, when they use Fee Basis care as a substitute, and how the mix of specialist and generalist care are associated with disease-specific quality of care and health outcomes. This project will provide a health services foundation that will inform policy makers and researchers about how to balance generalists and specialists. In this project, we will use observational methods to examine patterns of specialty care for Veterans diagnosed with one or more of the following complex conditions: congestive heart failure (CHF), hepatitis C (HCV), or epilepsy. These three conditions were selected because multiple medical, surgical, mental health and substance use specialists are likely to be needed for management. In addition, primary care providers have varied experience in managing these patients (epilepsy is low, HCV is moderate and CHF is higher). Finally, they present different treatment challenges: epilepsy is relapsing and remitting, CHF is a chronic condition, and HCV is a virus that can be treated. The implementation and dissemination of this work is enhanced with partnerships with three VA operational offices and two QUERI centers. We will stay connected with Operational offices with a technical advisory panel.