MANAGEMENT BRIEF

Number 19 Overviews of Health Care Topics for VA Senior Managers February 2001

Primary Care: Providing Continuity and Accessibility

“Primary care improves the continuity and efficiency of health care by providing each veteran

with a primary caregiver or primary care team that is accountable and accessible.

HSR&D contributes to this effort by conducting research on strategies that enhance

the delivery, quality, and cost-effectiveness of primary care among veterans.”

John G. Demakis, MD

Director, Health Services Research and Development Service

What is VHA primary care?

Primary care is the provision of continuous, comprehensive, and coordinated care that is undifferentiated by patient

gender, disease, or organ system. Primary care, provided by a

primary caregiver or primary care team, is characterized by

four key features: accessibility to a primary care site; continuity of care, which is defined by an ongoing relationship

between provider and patient; comprehensive care that

includes a primary caregiver who can arrange for a full range

of services; and coordination of care that avoids duplication

and enhances efficiency.

How has primary care evolved within VHA?

As the Veterans Health Care System developed through the

1950s and ‘60s, it emphasized hospital inpatient care, medical

specialization, and high technology. Four decades later VHA

adapted to an evolving health care environment, as well as the

changing needs of its veterans. A major component of VHA’s

organizational transformation was the Primary Care Initiative.

When this initiative was launched in 1995, about 10 percent

of VA patients were assigned to primary care. Four years

later, essentially all patients were assigned to a primary care

team and more than 80 percent of veteran patients could

name their primary caregiver.1

Another VA strategy for improving the quality of primary

care delivery was the establishment of Community-Based

Outpatient Clinics (CBOCs) that allow veterans more convenient access to care. A CBOC can be a VA-operated clinic or

a VA-funded or reimbursed health care facility that is separate

from the main or “parent” VA medical facility. The specific

goals/objectives of CBOCs are to reduce travel time, shorten

waiting time for appointments, shorten clinic waiting time,

reduce cost of care, emphasize prevention, health promotion

and education, and improve patient satisfaction.2

 A recent

HSR&D study showed that, in general, CBOCs have been

successful in meeting these goals and objectives. Compared

to patients who were treated at “parent” VAMCs, CBOC

patients had more primary care visits, shorter clinic waiting

times, traveled shorter distances, and were more satisfied

with their care.3

Below is a brief discussion of some of the HSR&D

studies that examine the changes in primary care

and how they affect veteran health care.

Study evaluates managed care in VHA primary

care delivery systems

The reorganization of VA’s health care system has had a

profound effect on health care delivery and outcomes at the

facility level. Organizational changes include the rapid development of primary care systems and the implementation of

managed care policies and practices that aim to influence

provider behavior and patient demand. Several different types

of primary care delivery have emerged as a result of these

changes. However, evidence regarding their individual effectiveness is limited, as is information about the relationship

between organizational features and clinical and economic

performance.

This HSR&D study evaluated the organizational and primary care program features of VA medical centers, including

the adoption of managed care practices associated with high

and low facility performance. Focusing on all 178 VA medical centers (VAMCs) and 67 Satellite Outpatient Clinics

(SOCs), investigators used a cross-sectional organizational

survey to examine several aspects related to primary care

program features including provider mix, primary care resources, managed care practices, and patient characteristics.

VA HSR&D Management Brief February 2001 Page 1 of 4


References:

1. VA Research & Development New Initiatives: Meeting

Veterans Needs. Washington, DC: Department of Veterans

Affairs. Veteran Health Administration, Office of Research

& Development, 1999.

2. Community-Based Outpatient Clinics. URL site

http://vaww.va.gov/resdev/cboc.htm Site linked to five

CBOC reports.

3. Chapko MK, Fortney J, Borowsky S. CBOC Performance

Evaluation. Program implications and future performance

measures. March 2000 Report for HSR&D’s Management

Decision and Research Center based on HSR&D study

#MRR 98-015.

MANAGEMENT BRIEF is produced by the Management

Decision and Research Center, a program within VA’s Office

of Research & Development, Health Services Research &

Development Service. The purpose of the MANAGEMENT BRIEF

is to provide VA senior management with a concise and

timely overview of a specific health care topic that includes

topic definition, benefits, VA research activities, and resources for further information.

For more information about this issue of

MANAGEMENT BRIEF please contact:

Geraldine McGlynn, M.Ed., Manager, Information

Dissemination Program, MDRC (152-M), VA Boston

Healthcare System, 150 S. Huntington Avenue, Boston, MA

02130. Phone: 617-278-4433. Fax: 617-278-4438.

To access back issues of MANAGEMENT BRIEF and/or additional MDRC publications and reports, visit the Research and

Development web page at http://www.va.gov/resdev/prt, or

the Intranet site at http://vaww.va.gov/resdev/prt, or call the

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VA HSR&D Management Brief Number 19, February 2001 Page 4 of 4