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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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