George Sayre, PhD
George Sayre, PhD, is the recipient of the 2018 HSR&D Health System Impact Award. This award honors HSR&D- and QUERI-funded research that has had a direct and important impact on clinical practice or clinical policy within the VA health care system – and that has been successfully translated into VA’s policy or operations. As part of HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care (CIVIC), Dr. Sayre earned the Impact Award for critical contributions to VA’s efforts to ensure and improve Veterans’ access to care. Dr. Sayre’s research and evaluation work encompasses a breadth of VA access issues and implementation efforts including the multiple specialty care evaluations, the access stand-down, Veteran Choice Act, MyVA, and Choose VA.
Findings from Dr. Sayre’s work have provided the Veteran Office for Access to Care and other VA central offices (VACO) with invaluable insights into the experience of Veterans, VA providers, frontline staff and community stakeholders, ensuring that their voices are heard by policymakers. For example, during the 2014 waitlist stand-down, Dr. Sayre was tasked by the VA Office of Analytics and Business Intelligence to analyze brief interviews from frontline staff at every VA healthcare facility. Dr. Sayre assembled a national team that conducted a rapid content analysis that identified the breadth of specific waitlist problems and provided insight into the systemic “moral hazard” experienced by frontline staff in the face of a rapidly increasing Veteran patient population and mandated 14-day access time limits. Findings from this study were included in VA’s 2014 internal waitlist evaluation presented to Congress.
Partly in response to the VA waitlist report, Congress passed the Veteran Choice Act in 2014. In his evaluation of the VCA, “Accessing Care Through the Veterans Choice Program: The Veteran Experience” (Sayre et al., 2018), Dr. Sayre identified significant barriers (complexity and lack of available local providers) that are most likely to impact the very Veterans who need access to community care the most—those who have cognitive impairments, more complex health issues, declining self-management capacity, and/or live in rural communities. Findings from the ongoing Choose VA access evaluation also identified negative impacts from the VCA on relationships with local community providers that may impact the implementation of the VA Mission Act of 2018. The Mission Act combines seven VA community care programs, including the VCA, into one program to make efficient use of VA healthcare resources. Dr. Sayre was recruited to examine the Mission Act. Drawing on findings from his previous and ongoing access research, he identified critical potential challenges to effectively implementing the Mission Act, most notably, that the possibility that any increased burden placed on community providers to comply with future VA quality standards will result in decreased participation and, thus, negatively impact access to care in the community. These findings have been shared with the Mission Act Quality Workgroup and will be incorporated into VA’s report to Congress.
Beginning with his analysis of the 2014 Waitlist Stand-down data, through evaluations of the Veteran Choice Act (VCA), MyVA, Choose VA, and now the Mission Act, Dr. Sayre’s work has ensured that VA’s national policy and access efforts are informed by the voices of Veterans – and the providers and staff who work on the frontlines. The understanding of Veteran, provider, and staff perspectives on access is critical during this period as the VA transitions from the VCA to the Mission Act to expand access to quality care in the community. As Director of the Qualitative Research Core for CIVIC, Dr. Sayre continues to provide methodological support for a wide variety of local and national research projects, including as qualitative lead for two HSR&D/QUERI national programs – Improving Safety and Quality and Virtual Specialty Care, in addition to the VA Collaborative Evaluation (VACE) center. Dr. Sayre also is principal investigator of the Choose VA access evaluation.
HSR&D thanks Dr. Sayre for his exceptional work and continuing contributions toward improving the VA healthcare system and the care and health of our Veterans.
HSR&D also thanks Health System Impact Award Nominee Jan Lindsay, PhD, for her (and her team’s) outstanding work on increasing the uptake of video-to-home technology by rural VA mental health providers and Veterans. Dr. Lindsay is part of HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt),