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Health Systems Research

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Partnered Evaluation of the Social Determinants of Health and Healthcare

Littman AJ, Bollinger M, Wong ES, Finley E, Fortney JC, Pyne JM, Drummond KL, Abraham TH, Townsend J, Mader M, Lee JS, Batten A, Bosworth HB, Boyko EJ, Hudson TJ. Partnered Evaluation of the Social Determinants of Health and Healthcare. Poster session presented at: VA Rural Health State of the Science Conference; 2016 Sep 12; Washington, DC.


Objectives: To: 1) characterize geographic variation in access, utilization, quality, satisfaction, and outcomes for rural Veterans, 2) identify the socioeconomic, cultural and environmental factors associated with geographic variation in outcomes assessed in Aim 1; 3) describe perceived access and need and identify preferences for and barriers and facilitators to healthcare and achieving optimal health and well-being among rural Veterans in areas with high and low utilization and enrollment; and 4) identify strategies and opportunities to support innovative partnerships with community, state and federal organizations to optimize the health and well-being of rural Veterans. Methods: Our work is guided by the SOTA model of access and the Healthy People 2020 framework to operationalize social determinants of health. We are using both quantitative (Aims 1 and 2) and qualitative (Aims 3 and 4) methods to conduct analyses. Aims 1 and 2 are being conducted using VA administrative data (e.g., CDW), VA surveys (e.g., SHEP, VA Survey of Veteran Enrollees' Health), Centers for Medicare/Medicaid data, and individual and aggregated national publically-available data (e.g., American Communities Survey, County Health Rankings). Results: Analyses and interviews are underway. Areas with high and low enrollment and utilization have been identified and ten counties (five with low and five with high utilization and enrollment -- two total in each VHA district) have been selected for sampling for Veteran and stakeholder interviews. Key deliverables include: an interactive atlas (Aim 1), an electronic chart book that includes both tabular data and a narrative of individual-, community/regional-, and system-level social determinants that contribute to the observed geographic variation (Aim 2), a nationally-representative depiction of Veterans' perceptions of the contributors to high/low access/utilization/outcomes and region-specific approaches to facilitate improved healthcare, health, and well-being for Veterans living in rural areas (Aim 3), an annotated directory of resources and potential partners to improve the well-being of rural Veterans (Aim 4). Implications: This project represents a unique and collaborative effort to obtain timely and actionable assessments to improve access, Veteran satisfaction, quality, and outcomes. Impacts: This project will gauge where gaps in care for rural Veterans exist, gain a better understanding of the reasons for those gaps, and identify opportunities for innovative partnerships between VA and other governmental and non-governmental entities.

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