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Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records.

Publication ,  Journal Article
O'Hare, AM; Butler, CR; Laundry, RJ; Showalter, W; Todd-Stenberg, J; Green, P; Hebert, PL; Wang, V; Taylor, JS; Van Eijk, M; Matthews, KL ...
Published in: JAMA Intern Med
July 1, 2022

IMPORTANCE: Since 2014, when Congress passed the Veterans Access Choice and Accountability (Choice) Act (replaced in 2018 with the more comprehensive Maintaining Internal Systems and Strengthening Integrated Outside Networks [MISSION] Act), the Department of Veterans Affairs (VA) has been paying for US veterans to receive increasing amounts of care in the private sector (non-VA care or VA community care). However, little is known about the implications of these legislative changes for the VA system. OBJECTIVE: To describe the implications for the VA system of recent increases in VA-financed non-VA care. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study was a thematic analysis of documentation in the electronic health records (EHRs) of a random sample of US veterans with advanced kidney disease between June 6, 2019, and February 5, 2021. EXPOSURES: Mentions of community care in participant EHRs. MAIN OUTCOMES AND MEASURES: Dominant themes pertaining to VA-financed non-VA care. RESULTS: Among 1000 study participants, the mean (SD) age was 73.8 (11.4) years, and 957 participants (95.7%) were male. Three interrelated themes pertaining to VA-financed non-VA care emerged from qualitative analysis of documentation in cohort member EHRs: (1) VA as mothership, which describes extensive care coordination by VA staff members and clinicians to facilitate care outside the VA and the tendency of veterans and their non-VA clinicians to rely on the VA to fill gaps in this care; (2) hidden work of veterans, which describes the efforts of veterans and their family members to navigate the referral process, and to serve as intermediaries between VA and non-VA clinicians; and (3) strain on the VA system, which describes a challenging referral process and the ways in which cross-system care has stretched the traditional roles of VA staff and clinicians and interfered with VA care processes. CONCLUSIONS AND RELEVANCE: The findings of this qualitative study describing VA-financed non-VA care for veterans with advanced kidney disease spotlight the substantial challenges of cross-system use and the strain placed on the VA system, VA staff and clinicians, and veterans and their families in recent years. These difficult-to-measure consequences of cross-system care should be considered when budgeting, evaluating, and planning the provision of VA-financed non-VA care in the private sector.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 1, 2022

Volume

182

Issue

7

Start / End Page

710 / 719

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Qualitative Research
  • Male
  • Kidney Diseases
  • Humans
  • Female
  • Delivery of Health Care
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
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O’Hare, A. M., Butler, C. R., Laundry, R. J., Showalter, W., Todd-Stenberg, J., Green, P., … Carey, E. (2022). Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records. JAMA Intern Med, 182(7), 710–719. https://doi.org/10.1001/jamainternmed.2022.1379
O’Hare, Ann M., Catherine R. Butler, Ryan J. Laundry, Whitney Showalter, Jeffrey Todd-Stenberg, Pam Green, Paul L. Hebert, et al. “Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records.JAMA Intern Med 182, no. 7 (July 1, 2022): 710–19. https://doi.org/10.1001/jamainternmed.2022.1379.
O’Hare AM, Butler CR, Laundry RJ, Showalter W, Todd-Stenberg J, Green P, et al. Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records. JAMA Intern Med. 2022 Jul 1;182(7):710–9.
O’Hare, Ann M., et al. “Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records.JAMA Intern Med, vol. 182, no. 7, July 2022, pp. 710–19. Pubmed, doi:10.1001/jamainternmed.2022.1379.
O’Hare AM, Butler CR, Laundry RJ, Showalter W, Todd-Stenberg J, Green P, Hebert PL, Wang V, Taylor JS, Van Eijk M, Matthews KL, Crowley ST, Carey E. Implications of Cross-System Use Among US Veterans With Advanced Kidney Disease in the Era of the MISSION Act: A Qualitative Study of Health Care Records. JAMA Intern Med. 2022 Jul 1;182(7):710–719.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 1, 2022

Volume

182

Issue

7

Start / End Page

710 / 719

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Qualitative Research
  • Male
  • Kidney Diseases
  • Humans
  • Female
  • Delivery of Health Care
  • Aged