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.
Article info
Publication history
Published online: December 16, 2022
Accepted:
November 11,
2022
Received in revised form:
November 4,
2022
Received:
April 14,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding: This work was supported by the United States (U.S.) Department of Veterans Affairs, Health Services Research and Development Service [Service Directed Research Award #SDR20-197 and Research to Impact for Veterans Award #RVR19-484]. The authors have no conflicts of interest to declare. All co-authors have seen and agree with the contents of the article and there is no financial interest to report.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health, George Washington University.
