Improving health care through the U.S. Veterans Health Administration’s nationwide LGBTQ+ Veteran Care Coordinator Program

Abstract:Lesbian, gay, bisexual, trans-identifying, queer (LGBTQ+) veterans experience health and health care disparities. Health care organizations play a critical role in supporting recipients of care, particularly for underserved communities, such as LGBTQ+ patients. To improve health and reduce health care disparities for LGBTQ+ veterans, the Veterans Health Administration (VHA) in the United States (U.S.) created the LGBTQ+ Health Program, a national program that includes local coordinators called the LGBTQ+ Veteran Care Coordinator (VCC) Program. The LGBTQ+ VCC Program was established through VA policy and illustrates one example of how policy implementation can push forward health equity for marginalized populations. We conducted a process program evaluation of the LGBTQ+ VCC Program (launched in 2016) to assess the barriers and facilitators of the program as well as provide recommendations and tools to assist in program implementation. Guided by the Consolidated Framework for Implementation Research and enhanced by two health equity domains, we collected data from local coordinators (n=172) and regional network leads (n=15) from January–March 2022. Qualitative data were collected through focus groups and individual interviews with local coordinators (n = 41), former local coordinators (n=3), and regional network leads (n=6) from July–December 2022. A mixed-methods design was used for triangulation, analyzing quantitative data using descriptive statistics and qualitative data using template analysis. Findings indicate local coordinators and network leads value their work. They struggle navigating the VHA system including difficulty engaging local and network leadership as well as navigating interpersonal situations with staff and veterans. Although local coordinators and network leads are dedicated to the VCC program mission, systemic changes are necessary. Based on local coordinator and network lead feedback, it would be beneficial for health care facility and network leadership to increase their awareness of LGBTQ+ health policy and create systems of accountability related to program implementation.