Stryczek Krysttel C, Honsberger Mark, Ball Sherry L, Barnard Juliana G, Young Jessica P, Felker Bradford, Au David H, Ho P Michael, Kirsh Susan R, Sayre George G
VA Northeast Ohio Healthcare System, Research & Development, Cleveland, OH 44106, USA.
VA Eastern Colorado Health Care System, Center of Innovation for Veteran-Centered and Value-Driven Care, Aurora, CO 80045, USA.
Mil Med. 2023 Jul 22;188(7-8):e2439-e2447. doi: 10.1093/milmed/usad019.
The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans' health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans' access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites' efforts to improve VHA outreach and veterans' experiences with access.
This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff ("VHA staff") completed during 21 VHA medical center facility site visits between July and November 2017 and 48 telephone interviews with veterans completed between May and October 2018. Interviews and focus groups were transcribed and analyzed using deductive and inductive analysis to capture challenges and strategies to improve VHA health care access (VHA staff data), experiences with access to care (veteran data), barriers and facilitators to care (staff and veteran data), contextual factors, and emerging categories and themes. We developed focused themes describing perceived challenges, descriptions of VHA staff efforts to improve veteran outreach, and veterans' experiences with accessing VHA health care.
VHA staff and veteran respondents reported a lack of veteran awareness of eligibility for VHA services. Veterans reported limited understanding of the range of services offered. This awareness gap served as a barrier to veterans' ability to successfully access VHA health care services. Veterans described this awareness gap as contributing to delayed VHA enrollment and delayed or underutilized health care benefits and services. Staff focused on community outreach and engaging veterans for VHA enrollment as part of their efforts to implement the ChooseVA access initiative. Staff and veteran respondents agreed that outreach efforts were helpful for engaging veterans and facilitating access.
Although efforts across VHA programs informed veterans about VHA services, our results suggest that both VHA staff and veterans agreed that missed opportunities exist. Gaps include veterans' lack of awareness or understanding of VHA benefits for which they qualify for. This can result in delayed access to care which may negatively impact veterans, including those separating from the military and vulnerable populations such as veterans who experience pregnancy or homelessness.
退伍军人健康管理局（VHA）的任务是为退伍军人提供医疗保健服务。然而，许多符合条件的退伍军人尚未注册或未充分利用VHA服务。在退伍军人注册VHA护理之前，进一步研究获取医疗服务的障碍对于了解如何解决这一问题是必要的。“选择VHA（原MyVA Access）”倡议旨在实现这一使命，以改善退伍军人获得医疗保健的机会。尽管该倡议没有专门涉及退伍军人外展工作，但它是改善退伍军人获得医疗保健机会的关键组成部分。这项对VHA实施情况的多地点评估结果描述了各地点为改善VHA外展工作和退伍军人的就医体验所做的努力。
这项质量改进评估采用了多方法定性研究方法，包括在2017年7月至11月期间对21个VHA医疗中心设施进行现场访问时，与VHA提供者和工作人员（“VHA工作人员”）进行的127次半结构化访谈和81次焦点小组讨论，以及在2018年5月至10月期间对退伍军人进行的48次电话访谈。对访谈和焦点小组讨论进行转录，并使用演绎和归纳分析方法进行分析，以获取改善VHA医疗保健服务获取的挑战和策略（VHA工作人员数据）、就医体验（退伍军人数据）、就医障碍和促进因素（工作人员和退伍军人数据）、背景因素以及新出现的类别和主题。我们制定了重点主题，描述了感知到的挑战、VHA工作人员为改善退伍军人外展工作所做的努力，以及退伍军人获取VHA医疗保健服务的体验。
VHA工作人员和退伍军人受访者报告称，退伍军人对VHA服务资格缺乏了解。退伍军人表示对所提供服务的范围了解有限。这种认知差距成为退伍军人成功获取VHA医疗保健服务的障碍。退伍军人将这种认知差距描述为导致VHA注册延迟以及医疗保健福利和服务延迟或未充分利用的原因。工作人员将社区外展和促使退伍军人注册VHA作为他们实施“选择VHA”获取倡议努力的一部分。工作人员和退伍军人受访者一致认为，外展工作有助于吸引退伍军人并促进他们获得服务。
尽管VHA各项目的努力让退伍军人了解了VHA服务，但我们的结果表明，VHA工作人员和退伍军人都认为存在错失的机会。差距包括退伍军人对其有资格享受的VHA福利缺乏认识或了解。这可能导致获得医疗服务的延迟，这可能对退伍军人产生负面影响，包括那些从军队退役的人员以及诸如怀孕或无家可归的退伍军人等弱势群体。
