Excerpt

Recently, researchers within the Department of Veterans Affairs (VA) have begun to develop an updated conceptualization of access which takes into account the impact of new technology on access and places a greater focus on outcomes beyond increased access. Specifically, the new conceptualization acknowledges post-access outcomes such as satisfaction, symptom levels, and functioning. As such, we sought to conduct a review of the literature that would clarify the current state of knowledge regarding the link between access to healthcare and system-level (e.g., utilization, satisfaction with care) and patient-level (quality of life, symptoms, mortality) outcomes. Given VA’s continuing commitment to improving access for veterans, we also examined the efficacy of interventions designed to improve access, with a focus on access, system-level, and patient-level outcomes.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • CONCLUSIONS
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT, TECHNICAL EXPERT PANEL
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 WHAT IS THE EVIDENCE THAT VARIATION IN VETERANS' ABILITY TO OBTAIN NEEDED HEALTH CARE (I.E., ACCESS) CONTRIBUTES TO VARIATION IN SYSTEM-LEVEL (E.G., UTILIZATION, SATISFACTION) OR PATIENT-LEVEL (E.G., QUALITY OF LIFE, FUNCTIONAL ABILITY, MORTALITY) OUTCOMES?
  • KEY QUESTION #1A DOES THE EFFECT OF ACCESS ON SYSTEM AND/OR PATIENT LEVEL OUTCOMES DIFFER BY PATIENT, TREATMENT, OR SETTING CHARACTERISTICS?
  • KEY QUESTIONS #2 AND #2A WHAT INTERVENTIONS HAVE BEEN SUCCESSFUL IN IMPROVING ACCESS FOR PATIENT POPULATIONS WITH REDUCED HEALTH CARE ACCESS? HAVE INTERVENTIONS THAT HAVE IMPROVED HEALTH CARE ACCESS LED TO IMPROVEMENTS IN SYSTEM LEVEL AND PATIENT LEVEL OUTCOMES?
• SUMMARY AND DISCUSSION
  • CONCLUSIONS
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B PEER REVIEW COMMENTS AND AUTHOR RESPONSES
• APPENDIX C EVIDENCE TABLES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Health Care System, Minneapolis, MN, Timothy J. Wilt, MD, MPH, Director

Suggested citation:

Kehle SM, Greer N, Rutks I, and Wilt TJ. Interventions to Improve Veterans Access to Care: A Systematic Review of the Evidence. VA-ESP Project #09-009; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Health Care System, Minneapolis, MN funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.