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FORUM - Translating research into quality health care for Veterans

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Director's Letter

David Atkins, M.D., M.P.H., Director, HSR&D

It is hard to take a flight or stay in a hotel today without getting surveyed about your customer experience. Businesses know they need to satisfy their customers if they want to stay in business. As healthcare has transformed into a fiercely competitive industry vying for patients, patient experience has risen to be as important as cost and quality in the metrics used to compare providers and hospitals. While patient satisfaction has always been important to the VA health system – what other hospital system has a corporate board whose members can get voted out by their patients? – it has taken on new importance as the Veteran population shrinks and healthcare options for Veterans increase. The majority of Veterans have always had other options for care – through Medicare, Medicaid, or private insurance – but passage of the MISSION Act in 2017 has expanded the number of current VA patients who can seek care in the community. Unless VA remains the provider of choice for these Veterans, a shrinking patient population will threaten our ability to provide comprehensive, high-quality care.

VHA assesses Veteran experience through annual mailed/online surveys–the Survey of Healthcare Experiences of Patients (SHEP) based on the industry standard Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys. These surveys ask about ability to access care, the quality of communication by doctors and nurses, and other questions such as whether they would recommend their hospital to other patients. Most of these data are publicly available at the VA Quality of Care portal where one can see how a particular VAMC compares to other VAs and to other hospitals in the area. Even more detailed information is available within the VA firewall on SHEP scores.

While VA has regularly performed better than Medicare or local competitors on numerous measures of quality, we have not always excelled on patient experience. One doesn’t always need research to improve patient experience – for example, lack of parking is a major driver for low satisfaction at some VAMCs – but health services research can play an important role in helping VA understand and address factors that shape patient experience. HSR&D researchers have examined effects of PACT implementation on patient experience,1 differences in the reported experience of women Veterans,2 and effects of factors such as provider turnover on primary care experience.3 VA researchers have also worked to expand our understand- ing of experience beyond the limited domains measured in CAHPS/SHEP to think what truly “patient centered” care would look like and how to measure it.

David Atkins, MD, MPH, Director, HSR&D



  1. Nelson KM, et “Implementation of the Patient-centered Medical Home in the Veter- ans Health Administration: Associations with Patient Satisfaction, Quality of Care, Staff Burnout, and Hospital and Emergency Department Use,” JAMA Internal Medicine 2014; 174(8):1350-8.
  2. Washington DL, et “Tailoring VA Primary Care to Women Veterans: Association with Patient-rated Quality and Satisfaction,” Women’s Health Issues 2011; 21(4 Sup- pl):S112-9.
  3. Reddy A, et “The Effect of Primary Care Provider Turnover on Patient Experience of Care and Ambulatory Quality of Care,” JAMA Internal Medicine 2015; 175(7):1157-62.

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