Why Veterans Choose VA Versus non-VA Emergency Care: A Qualitative Study.

Autor:	Vashi AA; Center for Innovation and Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.; Department of Emergency Medicine, University of California, San Francisco, CA 94143, USA.; Department of Emergency Medicine, Stanford University (Affiliated), Palo Alto, CA 94304, USA., Wong EP; Center for Innovation and Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA., Egelfeld JR; Center for Innovation and Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA., Asch SM; Center for Innovation and Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA 94025, USA.; Division of Primary Care and Population Health, Stanford Medicine, Stanford University, Stanford, CA 94304, USA., Nevedal AL; Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Nov 05; Vol. 189 (11-12), pp. e2655-e2664.
DOI:	10.1093/milmed/usae259
Abstrakt:	Introduction: In ensuring the timely delivery of emergency care to Veterans, Veterans Affairs (VA) offers both emergency care services in its own facilities and, increasingly, purchases care for Veterans in non-VA (community) emergency department (ED) settings. Although in recent years emergency care coverage has become the single largest contributor to VA community care spending, no study to date has examined Veteran decision-making as it relates to ED setting choice. The purpose of this study is to identify and describe reasons why Veterans choose VA versus non-VA emergency care settings. Materials and Methods: Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured telephone interviews from December 2018 through March 2020 with 50 Veterans to understand the factors Veterans consider when deciding where to obtain ED care. Interviews were audio-recorded and transcribed verbatim. We conducted a directed content analysis of interview transcripts and developed a matrix to summarize and categorize each Veteran's decision-making process to compare participants and to identify common patterns. Results: When choosing between VA and non-VA-EDs, Veterans described 3 distinct patterns of decision-making: (1) choosing the closest ED (often community) for acute conditions; (2) traveling farther for VA care due to preference and financial coverage; and (3) selecting VA when both types of ED care were equidistant. Perceptions of community resources, condition-specific needs, financial considerations, and personal preferences dominated the decision-making. For example, most Veterans (74%) rated their acuity as high, and self-perceived severity/urgency of their condition was the most cited factor influencing where Veterans decided to go for ED care. Conclusions: Our qualitative results help provide insight into how and why Veterans choose to seek emergency care. As the number of Veterans treated in non-VA EDs continues to rise, VA and non-VA ED providers as well as policy makers may benefit from understanding the challenges Veterans face when making this decision. (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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