Research to Improve Specialty Care Coordination

Research to Improve Specialty Care Coordination


My name is Varsha Vimalananda. I work at the Edith Nourse Rogers Memorial VA Medical Center in Bedford, Massachusetts. I’m on faculty at Boston University in the School of Medicine. My current research project is focused on coordination of specialty care. It’s a focus that really grew out my clinical experience providing care in the VA. So prior to coming to the VA, I had been doing my work in a university setting. And I had been in academic settings my entire life. That’s just what I was used to. We had problems with coordination at that time, but it seemed normal to me. And I never questioned that things could be any different. I started seeing patients at the Bedford VA around the same time I started to learn more about health services research. And started to realize that
through research in the VA, we were actually able to make changes to the way that clinical care was delivered. There are a lot of problems that occur when multiple providers share the care of one patient. Critical information is split amongst multiple providers, and that information isn’t always transmitted well among providers, and even the patient. And that puts the patient and the system and providers at risk for a lot of adverse outcomes. There’s the potential for devastating health consequences, in the case of a missed lab test or misdiagnosis, patients are often confused and frustrated when their care is fragmented, and providers are very often frustrated. So the VA is committed to improving coordination of care, particularly for veterans who considered very vulnerable. These individuals are very sick and they may visit up to 12 specialists a year, which means their healthcare information is split amongst, what could be a dozen, different providers. And they’re at the highest risk of poor outcomes. So in that setting, we are conducting a study to better understand what it means to have successful specialty care coordination from the perspectives of primary care providers, specialists, and also, critically, the patient. We have conducted interviews
with primary care providers, with specialists and with veteran patients. So when we interviewed these individuals, to understand what I means from their perspectives, we found that many of the things they look for in healthcare delivery are the same, but there are some things that are unique to each perspective. So we need to understand what those are, so that we know what potential targets for improvement are. Ultimately, my goal and the goal of most researchers is to improve care, which means translating research findings into practice. So, in order to do that, we need to understand what the organizational context is for the research that we want to implement. So, where are the biggest problems? What kinds of policies are in place that are going to support or potentially hinder our efforts? The Office of Specialty Care Services has partnered with me, in my research to help me understand some of these issues. The VA has prioritized coordination of specialty care, and thus far, they’ve focused primarily on specialist and PCP coordination. I think why the Office of Specialty Care Services is very interested in, in our work now, is that we’re brining the veteran perspective into that process as well. When we did our focus group at a rural VA, it was about a three hour drive for us, but for the veterans who came to join our focus group, for some of them it was a two hour drive one way. And having just driven three hours ourselves, we were trying to commiserate and sympathize with them over how long it took them to drive there, but none of them were fazed by that. They had driven two hours and were going to drive two hours back home because they wanted to participate in our focus group. And they wanted to help our research project. And they wanted to improve the way that care was delivered for their brothers and sisters in the VA. I was really touched that they were willing to drive that distance to join our focus group and share their experiences with us. And I feel that it’s our obligation to the best we can with the research findings that we collect from projects like that to actually improve healthcare delivery.

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