New Measure Shows VA Fulfilled Veterans' Timely Care Requests 86% of the Time Across Three Years
Timeliness, or the ability of a health system to provide care when requested, is a critical component of access and patient-centered care. To assess timeliness, measures need to include the length of time between the request for service, time it was provided, and the urgency of the request. Although timeliness is a goal of all healthcare systems, measures to assess it are limited. This retrospective cohort study sought to leverage VA's data infrastructure to generate an objective measure of the fulfillment of timely care requests, which could be tracked over time at multiple levels and adjusted for demographic, clinical, and geographic factors. Using VA data, investigators identified 1,467,566 timely care requests from 537,575 Veterans—instances when Veterans requested the next-available appointment or walked-in for care. They then sought to determine whether their new measure could assess the extent to which VA provided timely care (within 48 hours) through an outpatient or inpatient encounter or a secure message from a clinician. Investigators analyzed data from 160 VA primary care clinics associated with 24 healthcare systems in eight VISNs from June 2014 to June 2017. Adjustments were made for factors known to influence access and healthcare (i.e., patient demographics and rurality).
- Across 160 VA primary care clinics, requests for timely care were fulfilled 86% of the time (range 83% to 88%). Of all timely care requests, 98% were fulfilled by VA, with 61-68% in primary care, followed by 26-31% in other VA clinics, and 3% in mental health clinics. Less than 1% of requests were fulfilled with secure messaging.
- Between 2014 and 2017, 32% to 39% of VA primary care patients requested timely care, with the number of patients making timely care requests increasing by 24%.
- Over the study period, investigators identified 25 clinics (16%) that were either struggling or excelling at providing timely care.
- The patient population requesting timely care was younger and more likely to be female, black, and living in urban settings.
- An estimated 12% of timely care requests were not fulfilled, and such delays may drive patients outside VA. Using this timely care measure may assist in identifying reasons underlying access variability – and inform strategies to bring greater consistency of timely care across clinics.
- Investigators assumed schedulers accurately labelled the urgency of the appointment request. They also assumed that appointment cancellations or no-shows (10% of timely care requests) were not due to delayed care
This study was funded by VA’s Office of Rural Health and HSR&D. Dr. Nelson is part of HSR&D’s Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, and Dr. Kaboli is part of HSR&D’s Center for Access & Delivery Research and Evaluation (CADRE), Iowa City, IA.
Batten A, Augustine M, Nelson K, and Kaboli P. Development of a Novel Metric of Timely Care Access to Primary Care Services. Health Services Research. April 2020;55(2):301-309.