Vulnerability for Healthcare Communication Gaps for Users of VA Purchased Care: Implications for the Veterans Choice Act

Washington DL, Hamilton AB, Cordasco KM. Vulnerability for Healthcare Communication Gaps for Users of VA Purchased Care: Implications for the Veterans Choice Act. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 24; Toronto, Canada.

BACKGROUND: The recent Veterans Choice Act is designed to expand timely access to health care for Veterans Health Administration (VA) users through purchasing services from non-VA community providers. These care arrangements will potentially create coordination and communication gaps between patients' VA and non-VA providers, and between patients and their providers. Some Veteran populations may be particularly vulnerable for experiencing these communication gaps, increasing their risk for poor health outcomes. Our objective was to identify patient characteristics associated with communication gaps among Veterans using VA-purchased care delivered by non-VA providers. METHODS: We conducted a secondary data analysis of the National Survey of Women Veterans (NSWV), a 2008-09 population-based telephone survey of women Veterans (response rate 86%). Our analytic sample was comprised of 604 NSWV participants who used any VA-purchased non-VA provider care in the 12 months prior to the survey. Health care coordination and communication was measured with five questions that each assessed patient perceptions of communication (table). All measures used five-point Likert response options (all of the time; most of the time; some of the time; rarely; never). Responses of never, rarely, or some of the time were classified as indicative of a communication gap. We assessed prevalences of having any communication gap, and gaps by measure, followed by chi square and logistic regression analyses for the association of patient characteristics with each of the five measures. All analyses applied weights to account for the study design and response rate. RESULTS: Nearly half (46%) of the respondents perceived a communication gap in one or more of the measures. In unadjusted analyses, characteristics associated with a greater likelihood of a perceived communication gap were age 18-44 years (65%), being a college graduate (54%), being a newer Veteran (military service during the first Gulf War, the following peacetime, or during Operations Enduring Freedom/Iraqi Freedom/New Dawn [OEF/OIF/OND]) (59%), having a military service-connected disability (53%), and screening positive for a mood disorder (depression, anxiety, or post-traumatic stress disorder) (54%).