A Quality Improvement Initiative Designed to Increase Veteran Choice and Consult Retention

Area of Science:

• Health Services Research
• Quality Improvement in Healthcare
• Veterans Affairs Healthcare Systems

Background:

• Veterans Affairs (VA) offers Community Care (CC) to enhance veteran access to healthcare.
• Changes in CC scheduling correlated with reduced surgical volumes.
• A project aimed to increase CC-eligible veteran retention from 66% to 76% by September 2024, emphasizing veteran autonomy.

Purpose of the Study:

• To investigate the impact of a decentralized scheduling process on the retention of Community Care-eligible veterans.
• To ensure veteran autonomy and choice were prioritized within the scheduling process.
• To address the decrease in expected surgical volumes linked to local CC scheduling changes.

Main Methods:

• A quality improvement team identified that veterans were not consistently offered a choice between VA and community care.
• A decentralized, individualized scheduling process was implemented to uphold veteran choice.
• Consult retention rates were monitored during the phased rollout across surgical disciplines.

Main Results:

• The new scheduling process resulted in a retention rate increase from 66.1% to 69.3%.
• Veteran choice was successfully upheld for over 5,500 individuals.
• The intervention demonstrated a modest improvement in consult retention.

Conclusions:

• Decentralized scheduling may not significantly impact patient retention in private and VA networks.
• Complex healthcare processes can inadvertently compromise patient-centered care.
• Maintaining patient-centered care should be the primary objective in healthcare system strategies.