Elsevier

Women's Health Issues

Volume 28, Issue 2, March–April 2018, Pages 165-171
Women's Health Issues

Women Veterans
Patient-Rated Access to Needed Care: Patient-Centered Medical Home Principles Intertwined

Related analyses were presented at the AcademyHealth Annual Research Meeting on June 25, 2017.
https://doi.org/10.1016/j.whi.2017.12.001Get rights and content

Abstract

Background

Primary care teams can facilitate access to care by helping patients to determine whether and when care is needed, and coordinating care across multiple clinicians and settings. Appointment availability metrics may or may not capture these contributions, but patients' own ratings of their access to care provide an important alternative view of access that may be more closely related to these key functions of care teams.

Procedures

We used a 2015 telephone survey of 1,395 women veterans to examine associations between key care team functions and patient-rated access to needed care. The care team functions were care coordination, in-person communication (between patient and care team), and phone communication (timely answers to health questions). We controlled for sociodemographics, health status, care settings, and other experience of care measures.

Key Findings

Overall, 74% of participants reported always or usually being able to see a provider for routine care, and 68% for urgent care. In adjusted analyses, phone communication was associated with better ratings of access to routine care (odds ratio [OR], 4.31; 95% CI, 2.65–6.98) and urgent care (OR, 2.26; 95% CI, 1.23–4.18). Care coordination was also associated with better ratings of access to routine care (OR, 1.66; 95% CI, 1.01–2.74) and urgent care (OR, 2.26; 95% CI, 1.23–4.18). Associations with in-person communication were not significant.

Conclusions

Access, communication, and care coordination are interrelated. Approaches to improving access may prove counterproductive if they compromise the team's ability to coordinate care, or diminish the team's role as a primary point of contact for patients.

Section snippets

Study Design and Sample

Data in this study are drawn from a cross-sectional survey of women veteran patients (n = 1,395) conducted between January and March 2015 at 12 VA medical centers participating in a Practice-Based Research Network for women veterans (Frayne et al., 2013). We used data from the baseline wave of a survey conducted as part of a cluster-randomized controlled trial, Implementation of Women's Health Patient Aligned Care Teams Study (Yano et al., 2016). To study factors related to care team functions

Results

As shown in Table 1, 73.5% of respondents indicated that they always or usually got an appointment for routine care as soon as they needed, whereas 66.5% reported that they always or usually saw a VA provider as soon as they needed for urgent care. Among those surveyed, 62.4% gave high ratings of care coordination, and 76% gave high ratings of in-person communication. Among those who called their provider's office with a health care question, 63% always or usually got an answer as soon as

Discussion

We identified substantial associations between key care team functions and patient ratings of access to needed care. In particular, phone communication was strongly associated with ratings of access: among patients who called their care team with a health question, those who reported a timely response were on average 25 percentage points more likely to report good access (i.e., always or usually timely) to routine care, and 33 percentage points more likely to report good access to urgent care,

Conclusions

In this sample of women veterans, our analysis identified both phone communication and care coordination as positively associated with patient ratings of access to routine and urgent care. The relationship between in-person communication and access was not significant. Recognizing the degree to which ratings of access are intertwined with these key care team functions should inform the strategies used to improve access to needed care.

Julian Brunner, MPH, is a health services researcher at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy and a PhD candidate in Health Policy and Management at the UCLA Fielding School of Public Health.

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    • Cited by (0)

    Julian Brunner, MPH, is a health services researcher at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy and a PhD candidate in Health Policy and Management at the UCLA Fielding School of Public Health.

    Emmeline Chuang, PhD, is a health services researcher and Assistant Professor, Health Policy and Management at the UCLA Fielding School of Public Health. Her research focuses on organizational factors affecting service access and quality of care for low-income women and children.

    Donna L. Washington, MD, MPH, is Women's Health Focused Research Area Lead, VA HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy; and Professor of Medicine, UCLA. Her research interests include the health care needs of women, and vulnerable/underserved populations.

    Danielle E. Rose, PhD, is a health research scientist at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, where her research focuses on organizational influences on quality in primary care and women's health settings.

    Catherine Chanfreau-Coffinier, PhD, is a Postdoctoral Fellow in Health Services Research at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy. Her research focuses on patient experience and quality of care.

    Jill E. Darling, PhD, MSHS, is a Research Scientist at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and is currently Survey Director at USC's Center for Economic and Social Research. Her expertise is in health care survey methods.

    Ismelda A. Canelo, MPA, is a Health Science Specialist, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. She has 20 years of experience managing VA primary care and women's health organizational and implementation research.

    Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Adjunct Professor, Health Policy and Management, UCLA Fielding School of Public Health. Her research focuses on implementing research into evidence-based practice and policy.

    This project was funded by the VA HSR&D Service Women Veterans Healthcare CREATE project on Implementation of Women's Health Patient Aligned Care Teams (Project #CRE 12-026), a cluster randomized trial registered in ClinicalTrials.gov #NCT02039856. Funding was also provided by VA HSR&D SDR 10-012 (Women's Health Research Network, PIs Yano, Frayne, Hamilton). The study was conducted in partnership with VA Women's Health Services. Mr. Brunner's effort was supported by a predoctoral fellowship awarded by NIH/National Center for Advancing Translational Science (NCATS), UCLA CTSI Grant Numbers TL1TR000121 and TL1TR001883. Dr. Yano's effort was funded by a VHA HSR&D Senior Research Career Scientist Award (Project # RCS 05-195), the Women's Health Research Consortium/Practice-Based Research Network (# SDR 10-012), and the VHA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (# CIN 13-417). Dr. Chanfreau-Coffinier was supported by the VA Office of Academic Affiliations, Washington, DC, through the Advanced Fellowship in HSR&D. The authors acknowledge the editorial review and feedback of Chloe Bird, PhD, Senior Sociologist, RAND Corporation, Santa Monica. Her time was supported through the VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy (Project #CIN 13-417). The authors also acknowledge the staff of Davis Research, LLC, of Calabasas, California who assisted with pretesting and training, interfaced with the VA Veteran Crisis line to ensure participant emotional safety, and conducted the telephone survey. Finally, the authors thank the many women veterans who participated in this study's patient survey for their time and for sharing their experiences with VA care. The views expressed in this study are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

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