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Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from non‐VA Hospitals to Primary Care in a Single VA Healthcare System
Author(s) -
Ayele Roman A,
Lawrence Emily,
McCreight Marina,
Fehling Kelty,
Glasgow Russell E,
Rabin Borsika A,
Burke Robert E,
Battaglia Catherine
Publication year - 2020
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3320
Subject(s) - veterans affairs , medicine , health care , pharmacy , family medicine , formulary , medline , qualitative research , nursing , medical emergency , social science , sociology , political science , law , economics , economic growth
BACKGROUND Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non‐VA hospitals. These dual‐use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions. OBJECTIVES The aim of this study was to understand the barriers and facilitators to providing high‐quality continuum of care for veterans transitioning from non‐VA hospitals to the VA primary care setting. DESIGN Guided by the practical robust implementation and sustainability model (PRISM) and the ideal transitions of care, we conducted a qualitative assessment using semi‐structured interviews with clinicians, staff, and patients. SETTING This study was conducted at a single urban VA medical center and two non‐VA hospitals. PARTICIPANTS A total of 70 participants, including 52 clinicians and staff (23 VA and 29 non‐VA) involved in patient transition and 18 veterans recently discharged from non‐VA hospitals, were included in this study. APPROACH Data were analyzed using a conventional content analysis and managed in Atlas.ti (Berlin, Germany). RESULTS Four major themes emerged where participants consistently discussed that transitions were delayed when they were not able to (1) identify patients as veterans and notify VA primary care of discharge, (2) transfer non‐VA hospital medical records to VA primary care, (3) obtain follow‐up care appointments with VA primary care, and (4) write VA formulary medications for veterans that they could fill at VA pharmacies. Participants also discussed factors involved in smooth transition and recommendations to improve care coordination. CONCLUSIONS All participants perceived the current transition‐of‐care process across healthcare systems to be inefficient. Efforts to improve quality and safety in transitional care should address the challenges clinicians and patients experience when transitioning from non‐VA hospitals to VA primary care.