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Abstract

The current study evaluates changes in access as a result of the MyVA Access program—a system-wide effort to improve patient access in the Veterans Health Administration. Data on 20 different measures were collected, and changes were analyzed using t tests and Chow tests. Additionally, organizational health—how able a system is to create health care practice change—was evaluated for a sample of medical centers (n = 36) via phone interviews and surveys conducted with facility staff and technical assistance providers. An organizational health variable was created and correlated with the access measures. Results showed that, nationally, average wait times for urgent consults, new patient wait times for mental health and specialty care, and slot utilization for primary and specialty care patients improved. Patient satisfaction measures also improved, and patient complaints decreased. Better organizational health was associated with improvements in patient access.

Keywords

veteran access to care organizational health health care utilization

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References

Prentice

Davies

Pizer

SD.

Which outpatient wait-time measures are related to patient satisfaction?

Am J Med Qual. 2014;29:227-235.

Hoge

Auchterlonie

Milliken

CS.

Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295:1023-1032.

Lemke

Boden

Kearney

et al . Measurement-based management of mental health quality and access in VHA: SAIL mental health domain. Psychol Serv. 2017;14(1):1.

May

Pringle

MyVA Access Evaluation: Final Report. Pittsburgh, PA: University of Pittsburgh; 2016.

Freeborn

Greenlick

MR.

Evaluation of the performance of ambulatory care systems: research requirements and opportunities. Med Care. 1973;11:68-75.

Millman

Access to Health Care in America. Washington, DC: National Academies Press; 1993.

Andersen

Davidson

Baumeister

. Improving access to care. Kominski

, ed. Changing the US Health Care System: Key Issues in Health Services Policy and Management. San Francisco, CA: Jossey-Bass; 2014:33-65.

Gold

Beyond coverage and supply: measuring access to healthcare in today’s market. Health Serv Res. 1998;33(3 pt 2):625-652.

Fortney

Burgess

Jr Bosworth

Booth

Kaboli

PJ.

A re-conceptualization of access for 21st century healthcare. J Gen Intern Med. 2011;26:639-647.

10.

Karikari-Martin

Use of healthcare access models to inform the patient protection and affordable care act. Policy Polit Nurs Pract. 2010;11:286-293.

11.

De Smet

Schaninger

Smith

. The hidden value of organizational health—and how to capture it. McKinsey Q. 2014:69-79.

12.

Begun

Zimmerman

Dooley

Health care organizations as complex adaptive systems. In: Mick

Wyttenbach

, eds. Advances in Health Care Organization Theory. San Francisco, CA: Jossey-Bass; 2003;253:288.

13.

Dooley

KJ.

A complex adaptive systems model of organization change. Nonlinear Dynamics, Psychology, and Life Sciences. 1997;1(1):69-97.

14.

Sturmberg

O’Halloran

Martin

. Healthcare reform: the need for a complex adaptive systems approach. In: Strumbrug

Martin

, eds. Handbook of Systems and Complexity in Health. New York, NY: Springer; 2013:827-853.

15.

US Department of Veterans Affairs. MyVA Access Implementation Guidebook. Washington, DC: US Department of Veterans Affairs; 2016.

16.

Monteleoni

Clark

Using rapid-cycle quality improvement methodology to reduce feeding tubes in patients with advanced dementia: before and after study. BMJ. 2004;329:491-494.

17.

Creswell

JW.

Qualitative Inquiry and Research Design: Choosing Among Five Approaches. Thousand Oaks, CA: Sage; 2013.

18.

Glaser

Strauss

AL.

The Discovery of Grounded Theory: Strategies for Qualitative Research. Piscataway, NJ: Transaction; 2009.

19.

Morse

. Designing funded qualitative research. In: Denzin

Lincoln

, eds. Handbook of Qualitative Inquiry. Thousand Oaks, CA: Sage; 1994:220-235.

20.

Veterans Health Administration. 2012 VHA Facility Quality and Safety Report. Washington, DC: Veterans Health Administration; 2012.

21.

Kofman

Senge

PM.

Communities of commitment: the heart of learning organizations. Org Dyn. 1993;22(2):5-23.

22.

Senge

. The leader’s new work: Building learning organizations. In: Hickman

, ed. Leading Organizations: Perspectives for a New Era. Thousand Oaks, CA: Sage; 1998:439-457.

23.

Uhl-Bien

Marion

McKelvey

Complexity leadership theory: shifting leadership from the industrial age to the knowledge era. Leadership Q. 2007;18:298-318.

24.

Kessler

Bierly

Gopalakrishnan

, Internal vs. external learning in new product development: effects on speed, costs and competitive advantage. R&D Management. 2000;30:213-224.

25.

Carroll

Patterson

Wood

Booth

Rick

Balain

A conceptual framework for implementation fidelity. Implement Sci. 2007;2(1):1.

26.

Damschroder

Aron

Keith

Kirsh

Alexander

Lowery

JC.

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):1.

27.

Daniel

Keegan

Are your performance measures obsolete?

Management Accounting. 1989;70(12):45-50.

28.

Purbey

Mukherjee

Bhar

Performance measurement system for healthcare processes. International Journal of Productivity and Performance Management. 2007;56:241-251.

29.

Box

JF.

Guinness, Gosset, Fisher, and small samples. Stat Sci. 1987;2(1):45-52.

30.

Chow

GC.

Tests of equality between sets of coefficients in two linear regressions. Econometrica. 1960;28:591-605.

31.

Bland

Altman

DG.

Statistics notes: Cronbach’s alpha. BMJ. 1997;314:572.

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MyVA Access: An Evaluation of Changes in Access for a System-Wide Program Implemented in the Veterans Health Administration

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