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Brown T, Fagerlin A, Samore MH, Harris AHS, Galyean P, Zickmund S, Pettey WBP, Vanneman ME. Information and resources VA health system leaders need to manage enrollment and retention for Post-9/11 veterans. Health Serv Res 2024; 59:e14351. [PMID: 39073213 PMCID: PMC11366952 DOI: 10.1111/1475-6773.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE To understand Veterans Health Administration (VA) leaders' information and resource needs for managing post-9/11 Veterans' VA enrollment and retention. DATA SOURCES AND STUDY SETTING Interviews conducted from March-May 2022 of VA Medical Center (VAMC) leaders (N = 27) across 15 sites, using stratified sampling based on VAMC characteristics: enrollment rates, number of recently separated Veterans in catchment area, and state Medicaid expansion status. STUDY DESIGN Interview questions were developed using Petersen et al.'s Factors Influencing Choice of Healthcare System framework as a guide. Interviews were transcribed verbatim, and two coders analyzed the interviews using Atlas.ti, a qualitative software program. Coders followed the qualitative coding philosophy developed by Crabtree and Miller, a process of developing codes for salient concepts as they are identified during the analysis process. DATA COLLECTION/EXTRACTION METHODS Two coders analyzed 22% (N = 6) of the interviews and discussed and adjudicated any discrepancies. One coder independently coded the remainder of the interviews. PRINCIPAL FINDINGS Several key themes were identified regarding facilitators and barriers for VA enrollment including reputation for high-quality VA care, convenience of VA services, awareness of VA services and benefits, and VA mental health services. Nearly every VA leader actively used tools and data to understand enrollment and retention rates and sought to enroll and retain more Veterans. To improve the management of enrollment and retention, VA leaders would like data shared in an easily understandable format and the capability to share data between the VA and community healthcare systems. CONCLUSIONS Enrollment and retention information is important for healthcare leaders to guide their health system decisions. Various tools are currently being used to try to understand the data. However, a multifunctional tool is needed to better aggregate the data to provide VA leadership with key information on Veterans' enrollment and retention.
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Affiliation(s)
- Todd Brown
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Angela Fagerlin
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Matthew H. Samore
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Alex H. S. Harris
- VA Palo Alto Health Care SystemCenter for Innovation to Implementation (Ci2i)Menlo ParkCaliforniaUSA
- Stanford University School of MedicineVA Palo Alto Health Care SystemMenlo ParkCaliforniaUSA
| | - Patrick Galyean
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Susan Zickmund
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Warren B. P. Pettey
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
| | - Megan E. Vanneman
- VA Salt Lake City Health Care SystemInformatics, Decision‐Enhancement and Analytic Sciences Center (IDEAS)Salt Lake CityUtahUSA
- University of Utah School of MedicineSalt Lake CityUtahUSA
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Vanneman ME, Samore MH, Zheng T, Pettey WB, Fagerlin A, Harris AH. Choosing Veterans Affairs: Determinants of post-9/11 Veterans' enrollment in Veterans Affairs health care. Medicine (Baltimore) 2023; 102:e34814. [PMID: 37603531 PMCID: PMC10443737 DOI: 10.1097/md.0000000000034814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/27/2023] [Indexed: 08/23/2023] Open
Abstract
Following recent policy changes, younger Veterans have particularly increased options for where to receive their health care. Although existing research provides some understanding of non-modifiable individual (e.g., age) and external community (e.g., non-VA provider supply) factors that influence VA enrollment, this study focused on modifiable facility access and quality factors that could influence Veterans' decisions to enroll in VA. In this cohort study, we examined enrollment in and use of VA services in the year following military separation as the binary outcome using mixed-effects logistic regressions, stratified by Active and Reserve Components. This study included 260,777 Active and 101,572 Reserve Component post-9/11 Veterans separated from the military in fiscal years 2016 to 2017. Independent variables included 4 access measures for timeliness of VA care and 3 VA quality measures, which are included in VA Medical Centers' performance plans. Eligible Veterans were more likely to enroll in VA when the closest VA had higher quality scores. After accounting for timeliness of VA care and non-modifiable characteristics, rating of primary care (PC) providers was associated with higher VA enrollment for Active Component (odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.007-1.020). Higher mental health (MH) continuity (OR = 1.039, 95% CI: 1.000-1.078) and rating of PC providers (OR = 1.009, 95% CI: 1.000-1.017) were associated with higher VA enrollment for Reserve Component. Improving facility-specific quality of care may be a way to increase VA enrollment. In a changing policy environment, study results will help VA leadership target changes they can make to manage enrollment of Veterans in VA and deliver needed foundational services.
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Affiliation(s)
- Megan E. Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Matthew H. Samore
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tianyu Zheng
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Warren B.P. Pettey
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Angela Fagerlin
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA
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Geraci JC, Dichiara A, Greene A, Gromatsky M, Finley E, Kilby D, Frankfurt S, Edwards ER, Kurz AS, Sokol Y, Sullivan SR, Mobbs M, Seim RW, Goodman M. Supporting servicemembers and veterans during their transition to civilian life using certified sponsors: A three-arm randomized controlled trial. Psychol Serv 2023; 20:248-259. [PMID: 37384439 PMCID: PMC10755060 DOI: 10.1037/ser0000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Transitioning servicemembers and veterans (TSMVs) face difficulties throughout their reintegration to civilian life, including challenges with employment, poor social connection, and elevated risk for suicide. To meet the needs of this high-risk population, national initiatives have leveraged community-based interventions. Authors conducted a three-arm randomized controlled trial (n = 200) to evaluate two community-based interventions. The first, Team Red, White, and Blue (RWB), connects TSMVs to their community through physical/social activities. The second, Expiration Term of Service Sponsorship Program (ETS-SP) provides one-on-one certified sponsors to TSMVs who provide support during the reintegration process. TSMVs were assessed at baseline, 3, 6, and 12 months. The primary hypothesis was not supported as reintegration difficulties and social support were not significantly different for participants randomly assigned to the two community-based interventions (Arm-2/RWB and Arm-3/RWB + ETS-SP), when the data from the separate arms were collapsed and combined, compared to the waitlist. The results did support the secondary hypothesis as Arm-3/RWB + ETS-SP had less reintegration difficulties over 12 months and initially had more social support compared to Arm-2/RWB, which suggest that augmenting interventions with sponsors outperforms participation in community-based interventions alone. Overall, the results show some limitations of the studied community-based interventions, as implemented and researched within this study. The authors identified factors that may have contributed to the null findings for the primary hypothesis, which can be addressed in future studies, such as addressing the unique needs of TSMVs, enrolling TSMVs into interventions prior to military discharge, measuring and improving participation levels, and providing stepped-care interventions based on risk levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Joseph C. Geraci
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
- Resilience Center for Veterans & Families, Teachers College, Columbia University, NY, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ariana Dichiara
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Ashley Greene
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Molly Gromatsky
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Erin Finley
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
- Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System
| | - Daniel Kilby
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Resilience Center for Veterans & Families, Teachers College, Columbia University, NY, NY
| | - Sheila Frankfurt
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
- Central Texas Veterans Healthcare System, Temple, TX
| | - Emily R. Edwards
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - A. Solomon Kurz
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
| | - Yosef Sokol
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sarah R. Sullivan
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Meaghan Mobbs
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
| | - Richard W. Seim
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
| | - Marianne Goodman
- Transitioning Servicemember/Veteran And Suicide Prevention Center (TASC), VISN 2 Mental Illness Research, Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY
- Center of Excellence for Research on Returning War Veterans, VISN 17, Doris Miller VA Medical Center, Waco, TX
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Kumar SR, Augustine MR, Sherman RL, Thysen JA, Zaidi M, Gorman DT, Geraci JC. Facilitating Veterans Health Administration Primary Care for Transitioning Servicemembers: a Novel Virtual Care Clinic. J Gen Intern Med 2023:10.1007/s11606-023-08192-6. [PMID: 37340263 DOI: 10.1007/s11606-023-08192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/24/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Sumit R Kumar
- James J. Peters VA Medical Center, Bronx, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Matthew R Augustine
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel L Sherman
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Julie A Thysen
- James J. Peters VA Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Zaidi
- James J. Peters VA Medical Center, Bronx, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Joseph C Geraci
- James J. Peters VA Medical Center, Bronx, NY, USA
- Teachers College, Columbia University, New York, NY, USA
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