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Health Services Research & Development

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FORUM - Translating research into quality health care for Veterans

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Director's Letter

Seth A. Eisen, M.D., M.Sc.

Veterans choose VA as their primary source of health care largely because it provides high quality, comprehensive, integrated care at relatively little or no cost. Access to health care, however, can be a vexing issue for Veterans, since the approximately 1,000 hospitals and free-standing outpatient clinics and other facilities do not nearly cover Veterans' health services needs across the expanse of the United States. This explains, in part, why a substantial majority of VA patients currently receives at least some health care from non-VA providers.

The implementation of health care reform during the next several years will facilitate access for all Americans (including Veterans) to a broad array of health services. VA patients may therefore find non-VA care increasingly attractive, reinforced by the convenience of Veterans' family members receiving services from those same non-VA sources.

In September 2010, some of the nation's leading VA and non-VA investigators participated in a State of the Art (SOTA) conference that addressed access to VA care for Veterans. Access was defined broadly, including directly observable and measurable access, and more difficult to measure patient perceived access. Research issues that were discussed included defining and measuring access; identifying access issues for special populations; characterizing the impact of access on utilization, quality, outcomes, and satisfaction; challenges associated with matching medically appropriate levels of access to patient perceptions of access needs; the impact of policy and organization on access; and identifying, evaluating, and implementing innovative approaches to improving access (emphasizing roles of computer technology and informatics). Manuscripts addressing access related topics commissioned as background papers for the SOTA or developed as a result of SOTA deliberations will be published in a special issue of the Journal of General Internal Medicine by summer 2011.

Investigators interested in pursuing access related issues are encouraged to thoughtfully align their research with VA objectives. Equally important, investigators must engage clinical, operations, and policy leadership in research concepts to help ensure that research objectives being addressed are likely to be relevant not only today, but several years in the future when results will be available.

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