Lead/Presenter: Christopher Miller, COIN - Bedford/Boston
All Authors: Miller CJ (VA Boston Center for Healthcare Organization and Implementation Research (CHOIR); Harvard Medical School Department of Psychiatry), Gurewich DA (VA Boston Center for Healthcare Organization and Implementation Research [CHOIR]), Garvin LA (VA Boston Center for Healthcare Organization and Implementation Research [CHOIR]) Pugatch M (VA Boston Center for Healthcare Organization and Implementation Research [CHOIR]) Koppelman E (Boston University School of Public Health) Pendergast J (VA Boston Center for Healthcare Organization and Implementation Research [CHOIR]) Harrington K (VA Boston Center for Healthcare Organization and Implementation Research [CHOIR]) Clark JA (Boston University School of Public Health)
The U.S. Department of Veterans Affairs (VA) is undergoing a major transformation to provide Veterans with timely access to efficient, high quality care, which includes care delivered in the community. Increased community care calls for greater attention to interorganizational care coordination, especially in rural areas where healthcare services may be scarce. Thus, we investigated care coordination as perceived by VA staff and their counterparts in Federally Qualified Health Centers (FQHC) that stand as the likely partners for VA in serving rural Veterans.
We used a semi-structured interview guide to complete qualitative interviews with VA and FQHC staff, including care coordinators and administrators. Our interview guide was informed by a recently developed model of interorganizational care coordination. Interviews were audio recorded and transcribed verbatim. We used Rapid Qualitative Inquiry (RQI) to guide our analyses, with an emphasis on identifying factors seen as central to effective interorganizational care coordination.
We interviewed a total of 57 care coordinators and administrators from a geographically diverse sample of eight VA medical centers and thirteen FQHCs. Results suggested five pivotal domains related to interorganizational care coordination at these sites: organizational mechanisms related to interorganizational care coordination; organizational culture regarding care coordination practices; relational coordination; contextual factors relevant to coordinating care for Veterans in rural areas; and the role of the Third Party Administrators charged with managing scheduling and reimbursement of community services through recent legislation. In each domain, interview respondents described challenges and opportunities for improving care coordination practices.
Interorganizational care coordination encompasses diverse tasks aimed at facilitating access to care, care quality, and follow-up services. Our findings emphasize the importance of attending to key contextual barriers in coordinating care for rural Veterans (e.g. travel distance), and illustrate the value of structural (e.g. HIT) and relational approaches (e.g. relational coordination) to enhancing such care coordination.
The landscape related to interorganizational care coordination is changing rapidly for VA. Our results suggest that maximizing the effectiveness of such care coordination will require a multilevel approach involving changes at the provider, clinic, and system level.