ArticleAmerican journal of public health2007
The evolution of changes in primary care delivery underlying the Veterans Health Administration's quality transformation.
Article in American journal of public health, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act.Journal of general internal medicine · 2024Article
- Uptake and Equity in Influenza Vaccination Among Veterans with VA Coverage, Veterans Without VA Coverage, and Non-Veterans in the USA, 2019-2020.Journal of general internal medicine · 2023Article
- User-centered design to improve clinical decision support in primary care.International journal of medical informatics · 2017Article
- Linkage between theory-based measurement of organizational readiness for change and lessons learned conducting quality improvement-focused research.Learning health systems · 2017Article
- Does Greater Continuity of Veterans Administration Primary Care Reduce Emergency Department Visits and Hospitalization in Older Veterans?Journal of the American Geriatrics Society · 2015Article
- Sharing a Playbook: Integrated Care in Community Health Centers in the United States.American journal of public health · 2015Article
- The Relationship between Same-Day Access and Continuity in Primary Care and Emergency Department Visits.PloS one · 2015Article
- Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams.Journal of general internal medicine · 2014Review
- First things first: foundational requirements for a medical home in an academic medical center.Journal of general internal medicine · 2014Article
- Teamlet structure and early experiences of medical home implementation for veterans.Journal of general internal medicine · 2014Article
- Challenges facing primary care practices aiming to implement patient-centered medical homes.Journal of general internal medicine · 2014Article
- The learners' perceptions survey-primary care: assessing resident perceptions of internal medicine continuity clinics and patient-centered care.Journal of graduate medical education · 2013Article
- Integration of women veterans into VA quality improvement research efforts: what researchers need to know.Journal of general internal medicine · 2010Review
- Therapists' roles in pressure ulcer management in persons with spinal cord injury.The journal of spinal cord medicine · 2009Article
- So much to do, so little time: care for the socially disadvantaged and the 15-minute visit.Archives of internal medicine · 2008Article
- Relationship quality and patient-assessed quality of care in VA primary care clinics: development and validation of the work relationships scale.Annals of family medicineArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesSuffering from waning demand, poor quality, and reform efforts enabling veterans to "vote with their feet" and leave, the Veterans Health Administration (VA) health care system transformed itself through a series of substantive changes. We examined the evolution of primary care changes underlying VA's transformation.
methodsWe used 3 national organizational surveys from 1993, 1996, and 1999 that measured primary care organization, staffing, management, and resource sufficiency to evaluate changes in VA primary care delivery.
resultsOnly rudimentary primary care was in place in 1993. Primary care enrollment grew from 38% in 1993 to 45% in 1996, and to 95% in 1999 as VA adopted team structures and increased the assignment of patients to individual providers. Specialists initially staffed primary care until generalist physicians and nonphysican providers increased. Primary care-based quality improvement and authority expanded, and resource sufficiency (e.g., computers, space) grew. Provider notification of admissions and emergency department, urgent-care visit, and sub-specialty-consult results increased nearly 5 times.
conclusionsAlthough VA's quality transformation had many underlying causes, investment in primary care development may have served as an essential substrate for many VA quality gains.
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