4066 — Care Access and Community Care

Lead/Presenter: Deborah Gurewich,  COIN - Bedford/Boston
All Authors: Gurewich DA (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers; Boston University School of Medicine ), Shwartz M (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers; Boston University Questrom School of Business), Beilstein-Wedel E (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers) Harrington K (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers) Davila H (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers) Rosen A (Center for Healthcare Organization & Implementation Research, Boston & Bedford VA Medical Centers; Boston University School of Medicine)

Objectives:
To improve care access, VA developed the Community Care (CC) program, which allows Veterans to receive services from non-VA providers. To date, Veterans receiving care through the program reportedly experience barriers to accessing needed care and VA has thus prioritized improving the program. However, there is limited large-scale evidence about how access in the CC program compares to the VA and whether care access within the CC program varies by service type, information critically needed to inform targeted quality improvement efforts. This study fills that gap.

Methods:
This study relied on VA Corporate Data Warehouse data and three wait time measures developed by the Partnered Evidence-Based Policy Resource Center (PEPREC) that for the first time harmonize wait time measures across VA and CC. The measures are: consult entry date to approved date (days until approved; DTA); approved date to appointment made date (days until scheduled; DTS), and; approved date to appointment date (days until completed; DTC). The sample was all Veterans who received one or more of five types of specialty service in VA and CC during FY14 thru FY18 (cardiology, gastroenterology/GI endoscopy, mental health, orthopedics, and urology).

Results:
Wait times for all five specialty services were significantly longer for CC compared to VA, especially as measured by DTA and DTS. For instance, across specialties within VA, DTS averaged 10 days; for CC, DTS averaged 30 days. Wait time differentials between CC and VA also varied by specialty type with the largest variance observed for gastroenterology/GI endoscopy and mental health services. Performance differentials also varied by study year. Forthcoming results will examine performance variation across CC programs.

Implications:
Wait times for CC exceed wait times for comparable services within VA. Wait time disparities between CC and VA are largely due to delays related to getting CC consults approved and scheduling CC appointments.

Impacts:
As VA increasingly relies on the CC program to facilitate Veteran access to timely, high quality care, it is essential that VA measure CC performance and understand where the programs is working well and less well and why. This study reports findings that can inform performance improvement efforts.