TABLE 1—
Survey Responses Regarding Changes in Veterans Health Administration (VA) Primary Care Delivery Over the Course of Its Reorganization: 1993–1999
| 1993 | 1996 | 1999 | |
| No. of VA medical centers | 163 | 160 | 160 |
| Primary care mission | |||
| Primary care implementation scale score, a mean (SD) | 5.7 (2.4) | 6.8 (2.0) | 8.0 (1.5) |
| Answered affirmatively to “Is a physician or team of physicians responsible for the overall health of each patient, including health promotion and disease prevention, management of acute and chronic medical conditions, and biopsychosocial problems (e.g., domestic violence, job performance impairment, depression)?”, % | 79.7 | 96.3 | 98.7 |
| Answer to “When fully implemented, does this primary care program expect to provide primary care to majority of veterans who receive care at your VA?”,b % | |||
| Definitely yes | 54.8 | 82.5 | |
| Probably yes | 25.0 | 13.8 | |
| Maybe | 7.1 | 0.6 | |
| Probably no | 11.9 | 2.5 | |
| Definitely no | 1.2 | 0.6 | |
| Percentage of unique patients in outpatient clinics obtaining most of their care through VA primary care clinic | |||
| All/Almost all (91–100%) | 13.9 | 14.5 | 61.6 |
| Most (61–90%) | 24.1 | 30.2 | 33.3 |
| About half (41–60%) | 19.0 | 27.7 | 4.4 |
| Some (21–40%) | 38.0 | 17.0 | 0.6 |
| A few (1–20%) | 5.1 | 5.7 | 0 |
| None (0%) | 0 | 1.9 | 0 |
| Don’t know/can’t estimate | 0 | 3.1 | 0 |
| Primary care reporting arrangement | |||
| Physicians, % | |||
| Service of origin | 41.5 | 20.8 | 12.2 |
| Primary care only | 6.1 | 20.8 | 55.4 |
| Both | 51.2 | 56.0 | 31.1 |
| Other | 1.2 | 2.5 | 1.4 |
| Registered nurses, % | |||
| Service of origin | 35.8 | 28.9 | 13.9 |
| Primary care only | 2.5 | 13.8 | 58.9 |
| Both | 60.5 | 55.3 | 25.6 |
| Other | 1.2 | 0.6 | 1.6 |
| Not applicable | . . . | 1.3 | . . . |
| Social workers, % | |||
| Service of origin | 59.5 | 40.3 | 23.5 |
| Primary care only | 1.3 | 6.9 | 44.5 |
| Both | 39.2 | 47.2 | 31.9 |
| Other | . . . | 0.6 | . . . |
| Not applicable | . . . | 5.0 | . . . |
| Physician assistants, % | |||
| Service of origin | 36.0 | 12.0 | 8.2 |
| Primary care only | 10.0 | 22.8 | 76.3 |
| Both | 54.0 | 32.9 | 14.4 |
| Other | . . . | 1.3 | 1.0 |
| Not applicable | 36.0 | 31.0 | . . . |
| Nurse practitioners, % | |||
| Service of origin | 26.1 | 19.0 | 13.4 |
| Primary care only | 8.7 | 17.7 | 66.4 |
| Both | 63.8 | 43.7 | 19.4 |
| Other | 1.4 | 0.6 | 0.7 |
| Not applicable | . . . | 19.0 | . . . |
| Primary care practice management | |||
| Frequency of formal primary care team meetings for patient care, % | |||
| More than once a week | 19.6 | 28.7 | 21.7 |
| About once a week | 41.3 | 34.7 | 19.6 |
| 2–3 times a month | 10.9 | 10.7 | 15.2 |
| About once a month | 21.7 | 17.3 | 23.2 |
| Less than once a month | 6.5 | 8.7 | 20.3 |
| Primary care providers promptly notified of hospital admissions, % | |||
| Always/almost always | 16.0 | 50.9 | 68.8 |
| Most of the time | 23.5 | 22.6 | 15.0 |
| Some of the time | 23.5 | 8.2 | 5.0 |
| Occasionally | 19.8 | 14.5 | 5.0 |
| Never | 12.3 | 3.1 | 6.2 |
| Not applicable/cannot estimate | 4.9 | 0.6 | 0 |
| Primary care providers promptly notified of long-term care admissions, % | |||
| Always/almost always | 12.5 | 27.2 | 41.5 |
| Most of the time | 13.8 | 18.4 | 9.5 |
| Some of the time | 21.3 | 10.8 | 12.9 |
| Occasionally | 27.5 | 22.2 | 13.6 |
| Never | 13.8 | 10.1 | 22.4 |
| Not applicable/cannot estimate | 11.3 | 11.4 | 0 |
| Primary care providers promptly notified of emergency department visits, % | |||
| Always/almost always | 2.5 | 15.7 | 17.2 |
| Most of the time | 16.3 | 24.5 | 17.9 |
| Some of the time | 21.3 | 22.6 | 18.5 |
| Occasionally | 30.0 | 24.5 | 15.9 |
| Never | 13.8 | 8.8 | 30.5 |
| Not applicable/cannot estimate | 6.3 | 3.8 | 0 |
| Primary care providers promptly notified of subspecialty consult results, % | |||
| Always/almost always | 3.7 | 14.5 | 12.1 |
| Most of the time | 29.6 | 27.0 | 23.6 |
| Some of the time | 19.8 | 20.8 | 28.0 |
| Occasionally | 34.6 | 25.2 | 18.5 |
| Never | 9.9 | 10.7 | 17.8 |
| Not applicable/cannot estimate | 2.5 | 1.9 | 0 |
| Primary care team coverage: inpatient care, % | |||
| Complete responsibility | 17.4 | 33.1 | 21.7 |
| Some responsibility | 21.7 | 29.8 | 13.2 |
| Little or no responsibility | 60.9 | 37.1 | 65.1 |
| Primary care team coverage: urgent care, % | |||
| Complete responsibility | 28.3 | 35.8 | 32.2 |
| Some responsibility | 60.9 | 58.9 | 50.6 |
| Little or no responsibility | 10.9 | 5.3 | 17.1 |
| Primary care team coverage: chronic care, % | |||
| Complete responsibility | 63.8 | 80.8 | 78.3 |
| Some responsibility | 34.0 | 17.2 | 12.5 |
| Little or no responsibility | 2.1 | 2.0 | 9.2 |
| Primary care team coverage: nursing home care, % | |||
| Complete responsibility | 4.3 | 10.1 | 5.3 |
| Some responsibility | 15.2 | 26.2 | 20.4 |
| Little or no responsibility | 80.4 | 62.4 | 74.3 |
| Primary care team coverage: emergent care, % | |||
| Complete responsibility | 13.3 | 14.6 | 10.5 |
| Some responsibility | 44.4 | 62.9 | 42.1 |
| Little or no responsibility | 42.2 | 22.5 | 47.4 |
| Primary care team coverage: patient phone calls requiring physician consultation, % | |||
| Complete responsibility | 48.9 | 60.3 | 53.3 |
| Some responsibility | 40.4 | 37.1 | 35.5 |
| Little or no responsibility | 10.6 | 2.6 | 11.2 |
| Primary care team coverage: team administration, % | |||
| Complete responsibility | 38.3 | 35.8 | 17.8 |
| Some responsibility | 55.3 | 55.0 | 55.3 |
| Little or no responsibility | 6.4 | 9.3 | 27.0 |
aIn this ordinal scale, 1 = start-up phase, 5 = mid-way, and 9 = fully implemented.
bThis is out of 84 medical centers with primary care programs for 1993, and out of all 160 medical centers for 1996 and 1999.