Care for Veterans With Advanced Kidney Disease Fractured by Lack of Coordination

By Linda Carroll

May 23, 2022

NEW YORK (Reuters Health) - Veterans with advanced kidney disease often have a tough time getting coordinated care when they are seeing both VA doctors and outside providers, a new study suggests.

An analysis of data from 1,000 veterans with advanced kidney disease reveals the lack of care coordination has a host of negative effects, including patients' difficulty navigating the referral process, VA doctors spending extra time trying to coordinate care with outside systems, and problems getting records and information from the outside systems, according to the report, published in JAMA Internal Medicine.

"Overall, the veterans need to remain at the center of their care and the VA system is doing as much as possible to get them the services they need, but it clearly takes more than the VA to do that because of difficulties integrating VA care and other community services," said Dr. Kameron Matthews, currently chief health officer at Cityblock in Brooklyn, New York, who worked on the study when she was at the Veterans Health Administration.

"A lot of this is because of the integration piece and poor communication between care teams inside and outside the VA," Dr. Matthews told Reuters Health by phone. "Records are not shared. And there are problems with referrals and authorizations."

To take a closer look at the experiences of veterans who were using both VA services and outside healthcare providers, Dr. Matthews and her colleagues turned to VA administrative and clinical data. The researchers identified a cohort of patients with evidence of advanced kidney disease and then randomly selected 1,000 of those veterans for detailed review of their electronic health records (EHRs).

The average age of the veterans in the analysis was 74, 96% were male and 69% white. The researchers found that 61% of the veterans had at least one active or paid claim for VA-financed non-VA care during follow-up.

After combing through the EHRs, the researchers found three main themes: the VA is expected to be the main coordinator of care; (2) veterans and their families need to put in a lot of work as they navigate the referral process and serve as intermediaries between VA and non-VA clinicians; and (3) the VA system is strained by the cross-system care and the traditional roles of VA staff and clinicians are stretched, which can interfere with VA care processes.

What the researchers found is not isolated to the VA, Dr. Matthews said.

"This is one example of how care between any different healthcare systems can unfortunately turn into a bad experience for a lot of patients," Dr. Matthews added. When patients are being cared for by more than one healthcare system, "they often have to navigate everything themselves and their care is often not coordinated."

The new study shows that "access alone is not enough," Dr. Matthews said. "The veterans still need services outside the VA and payment for those has been expanded. But there needs to be more integration with the veteran placed at the center."

SOURCE: JAMA Internal Medicine, online May 16, 2022.