The Evolution of Changes in Primary Care Delivery Underlying the Veterans Health Administration's Quality Transformation

Published in: American Journal of Public Health, v. 97, No. 12, Dec. 1, 2007, p. 2151-2159

Posted on RAND.org on January 01, 2007

by Elizabeth Yano, Barbara Simon, Andrew B. Lanto, Lisa V. Rubenstein

Read More

Access further information on this document at www.ajph.org

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVES: Suffering 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. The authors examined the evolution of primary care changes underlying VA's transformation. METHODS: The authors 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. RESULTS: Only 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. CONCLUSIONS: Although 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.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.