Timeliness of health care access in the Veterans Health Administration

Abstract:Introduction: Timely health care access is associated with improved health outcomes and increased patient satisfaction. Alternatively, delayed access to health care is associated with decreased ability of health systems to efficiently utilize resources, increased costs of care, and higher rates of missed appointments. The inability of Department of Veterans Affairs (VA) medical centers to consistently meet established patient appointment wait time standards has contributed to rising VA community care costs. The implementation of site-specific initiatives in VA medical centers has reduced Veterans Health Administration (VHA) direct care new patient appointment wait times compared to historical VHA appointment wait times and many private sector health care systems. However, there remains variability in VHA direct care average new patient appointment wait times not entirely explained by patient volume or geography. Research is also lacking regarding the perceptions and experiences of VA medical center group practice managers in the context of the timeliness of ambulatory mental health and primary care at VA medical centers. Methods: This explanatory sequential mixed methods study investigated variations in the timeliness of appointments for ambulatory mental health and primary care services for new patients at all VA medical centers currently using the Veterans Health Information Systems and Technology Architecture (VistA) medical record. This also explored VA medical center group practice managers’ perceptions of timely care in the VHA system, including enterprise-wide and facility-specific initiatives aimed at improving the timeliness of health care access across VHA. Results: The results from this study indicated that there is facility-level variation in the new patient appointment wait times and that there is opportunity to improve health care access timeliness with the VHA. Through interviews with VA medical center group practice managers, four qualitative themes emerged: The Personal Side of Things, Pulling in the Same Direction, Leadership’s Role in Change, and The Capacity of Technology & Data. Collectively, these themes underscore the multifactorial nature of health care access and support the need for effective partnerships between VA medical centers to promote the timeliness of health care access. Conclusion: The information and insights obtained through this research could be leveraged to improve consistency in the timeliness of health care access for new patients seeking primary care and ambulatory mental health services from VA medical centers nationwide. To support this improvement, a centralized database of VA medical centers’ access-related metrics and self-reported challenges or successes related to the emergent themes discovered through this study has the potential to foster innovation, standardization, and promulgation of promising practices across the VHA.