Provider Perspectives on the Coordination of Care for Spinal Cord Injured Veterans

Abstract

The Veterans Health administration (VHA) provides comprehensive care to their spinal cord injured and diseased (SCI/D) patients. By interviewing staff and providers serving this population this study aims to fill gaps in our knowledge of care coordination for this population. Purposive sampling was used to select administrators and clinical executives (n=25) representing 13 SCI/D facilities and the VHA Central Office. Semi-structured interviews were conducted and a qualitative description approach with deductive content analysis was used in analysis. Informants revealed that actual care coordination varies from, and extends beyond, that formalized in VHA Directive 1176. Major themes included the role of provider awareness of the SCI/D system in promoting referrals, challenges utilizing contractors and nursing facilities, difficulties maintaining care coordination between hub and spoke facilities, and the value of information technology and community organizations. By studying the experiences of our informants, we identified multiple opportunities for improving care coordination of Veterans with SCI/D.