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“We Are Working Harder, Not Smarter:” a Qualitative Inquiry Into Care Coordination for Department of Veterans Affairs Mammograms Referred to the Community

  • Author Footnotes
    1 First authorship shared equally between G.R. Monty and S.K. Benson.
    Gillian R. Monty
    Footnotes
    1 First authorship shared equally between G.R. Monty and S.K. Benson.
    Affiliations
    Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
    Search for articles by this author
  • Author Footnotes
    1 First authorship shared equally between G.R. Monty and S.K. Benson.
    Samantha K. Benson
    Correspondence
    Correspondence to: Samantha Benson, MPH, Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, VA Puget Sound Health Care System, 1660 S. Columbian Way, Mailstop S-152, Seattle, WA 98108. Phone: (206) 277-4177.
    Footnotes
    1 First authorship shared equally between G.R. Monty and S.K. Benson.
    Affiliations
    Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington
    Search for articles by this author
  • Stefanie A. Deeds
    Affiliations
    General Medicine Service, VA Puget Sound Health Care System, Seattle, Washington

    Department of Medicine, University of Washington School of Medicine, Seattle, Washington
    Search for articles by this author
  • Lisa S. Callegari
    Affiliations
    Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington

    Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, Washington

    Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
    Search for articles by this author
  • Jodie G. Katon
    Affiliations
    Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington

    Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
    Search for articles by this author
  • Kristina M. Cordasco
    Affiliations
    VA Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California

    Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Medicine, University of California Los Angeles (UCLA), Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Kristen E. Gray
    Affiliations
    Health Services Research & Development, Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington

    Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington
    Search for articles by this author
  • Author Footnotes
    1 First authorship shared equally between G.R. Monty and S.K. Benson.
Published:December 16, 2022DOI:https://doi.org/10.1016/j.whi.2022.11.004

      Abstract

      Introduction

      The Department of Veterans Affairs (VA) relies on facilities outside of VA to provide mammograms for most VA patients. Prior work suggests challenges to coordinating some sex-specific services between VA and other health care systems (e.g., gynecologic malignancies, maternity care), but little is known about barriers and facilitators to mammogram care coordination. We sought to describe processes for coordinating mammograms referred outside of VA and to characterize VA staff perspectives on care coordination barriers and facilitators.

      Methods

      We conducted semistructured interviews with 44 VA staff at 10 VA Medical Centers that refer all mammograms outside of the VA. Respondents included staff across multiple VA departments involved in coordinating mammograms. We used a rapid templated approach to analyze audio-recorded interviews to characterize the coordination processes and identify barriers and facilitators to care coordination.

      Results

      Interviews elucidated a common mammogram care coordination process, with variability in how process steps were achieved. We identified six themes: 1) the process is generally perceived as inefficient, 2) clarity in VA staff roles and responsibilities is essential, 3) internal VA communication facilitates coordination, 4) challenges arise from variability in community provider processes and their limited understanding of VA processes, 5) coordination challenges can negatively impact veterans, and 6) technology holds promise but remains a barrier.

      Conclusions

      Coordination of mammograms that are referred outside of VA is challenging for staff in multiple VA departments and roles. VA programs should focus on improving communication and role clarity within the VA and better harnessing technology to support coordination efforts.
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      Biography

      Gillian R. Monty, BA, is a research assistant in the VA Puget Sound Health Services Research & Development service.

      Biography

      Samantha K. Benson, MPH, is a research coordinator in the VA Puget Sound Health Services Research & Development service.

      Biography

      Stefanie A. Deeds, MD, is a primary care doctor, Director of the Primary Care Innovation Lab at VA Puget Sound, and an Assistant Professor of Medicine in the Division of General Internal Medicine at the University of Washington School of Medicine.

      Biography

      Lisa S. Callegari, MD, MPH, is a gynecologist, Core Investigator in the VA Puget Sound Health Services Research & Development service, and an Associate Professor of Obstetrics & Gynecology and Health Systems and Population Health at the University of Washington.

      Biography

      Jodie G. Katon, PhD, MS, is an epidemiologist and health services researcher, a Core Investigator in the VA Puget Sound Health Services Research & Development service, and a Research Assistant Professor in the University of Washington Department of Health Systems and Population Health.

      Biography

      Kristina M. Cordasco, MD, MPH, MSHS, is an internal medicine physician, a Core Investigator in the VA Greater Los Angeles Health Services Research & Development service, and a Clinical Professor of Medicine in the Geffen School of Medicine at the University of California-Los Angeles.

      Biography

      Kristen E. Gray, PhD, MS, is an epidemiologist and health services researcher, a Core Investigator in the VA Puget Sound Health Services Research & Development service, and a Research Assistant Professor of Health Systems and Population Health at the University of Washington.