Care coordination agreements in the Veterans Healthcare Administration

Purpose - The Veterans Healthcare Administration (VHA) has promoted Specialty Care Neighborhoods (SCN) to enhance the coordination of services between primary and specialty care. Care coordination agreements (CCAs) were included as a critical element in the SCN program. The purpose of this paper is to examine the role of these documents in the successful implementation of SCNs. Design/methodology/approach - Content, quality, and perceived usefulness of CCAs from 19 SCN sites were evaluated. CCA content was defined as the presence or absence of eight key components: contact information, process for urgent consults, process for e-consults, content of consults, primary and specialty care responsibilities, expected response time, discharge criteria, and review criteria. CCA quality was based on a qualitative assessment of CCA content; and perceived usefulness was based on a qualitative assessment of interview responses from CCA users. CCA characteristics were compared to SCN implementation levels using descriptive statistics. SCN implementation level was defined and measured by VHA Specialty Care Services. Findings - Participating sites with medium-high or high SCN implementation levels had CCAs with more key components and of higher quality than sites with medium-low to medium SCN implementation levels. Perceived usefulness of CCAs was not associated with implementation level. Research limitations/implications - Since this study built on a quality improvement effort to facilitate care coordination, a rigorous research approach was not used. Specific CCA components could not be examined nor could specific hypotheses be tested due to the small and diverse sample. Findings presented are only preliminary. Practical implications - The examination of CCAs suggests that these documents may be helpful to improve communication among primary and specialty care providers by explicitly stating agreed upon processes, mechanisms and criteria for referrals, roles and responsibilities for the co-management of patients, and timelines for review of CCAs. Originality/value - This small study suggests that high-quality CCAs, which include a number of key components, can facilitate the implementation of coordinated care. Key characteristics of CCAs are identified in this study, including measures of CCA content, quality, and usefulness, which can be used in future efforts to develop and evaluate efforts to improve care coordination.