Provider Effect on Outpatient Utilization in Veterans with Symptoms
Principal Investigator: Drew Helmer, MD, MS
Background: Primary care plays a central role in the delivery of health care in the VHA, a highly integrated, regionalized, national health care delivery system. The primary care provider (PCP) is the patient's point of primary contact, the care coordinator, the source of essential health education and preventive services, and an advocate for the patient. Despite the knowledge that many clinical interventions improved or prolonged health in randomized clinical trials, e.g., certain medications, there remains great variation in evidence-based health care delivery. More study is needed to determine how to improve the quality and effectiveness of primary care.
Objective:The two projects in this proposal examine the delivery of primary care, looking for ways to improve it. The projects will examine the association between patient, provider, organization and external factors and the clinical and process outcomes of the primary care delivery in two clinical conditions, diabetes (project 1) and medically unexplained chronic pain and fatigue (MUCPF) (project 2). These are common conditions in primary care, but the state of knowledge about delivering care for each is different and complementary. Diabetes has well accepted and defined treatments and outcome measures for evaluation whereas MUCPF treatments and outcome measures are less well established.
Research Project 1:This will project investigate the associations between organizational characteristics and the delivery of evidence-based diabetes care, as measured by diabetes process measures documented in both VHA and Medicare administrative data. Although the VHA has positioned itself as a model system of integrated health care delivery, nearly 75% of VHA utilizers with diabetes use some Medicare services. The coordination of care between the VHA and the private sector is not well understood. Using administrative data from both the VHA and Medicare will allow me to study totality of care and the organizational characteristics that affect health system of use.
Research Project 2: This project will investigate the organizational barriers and facilitators of implementing the MUCPF clinical practice guideline (CPG) in primary care. People with medically unexplained symptoms (MUS) utilize more health care resources and are less satisfied with their health care. Approximately 15% of veterans who served in Operation Desert Storm have MUS making the issue of deployment-related MUS highly visible for the VA. Although the VA adopted an evidence-based CPG to address MUCPF, there has been no evaluation of its effectiveness. The findings of this project will inform policy and directly impact the quality of care for veterans with MUCPF.
Significance: This research will provide evidence that policy makers, managers, and providers can apply to primary care delivery and its organizational features. The projects will provide the necessary base for further research on implementation and evaluation of a clinical practice guidelines and using claims data to monitor effectiveness of primary care delivery.
Status: The project is ongoing.