# Impacts of Organizational Variations on Access Management

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2022 · —

## Abstract

Background: Delays in care (i.e., poor access to timely care) are associated with adverse impacts on
morbidity, mortality and quality of life, as well as poor outcomes from physical and mental health conditions.
The VHA healthcare system has long struggled with access issues, however, VHA's “access crisis” in 2014,
where systemic access problems were identified after whistleblowers revealed intentional cover-ups of long
delays, drew particular outrage as evidence emerged that Veterans had died waiting to see their VHA doctors.
Improving Veterans' access to care continues to be among VHA's top priorities, and while expansion of access
to community providers has been among the most visible approaches to reducing waits and delays, VHA has
implemented numerous initiatives to improve Veterans' timely access to care within VHA as well. These
include development of a group practice manager role to facilitate face-to-face and virtual appointment-making
through call centers and access management tools (e.g., grid validation). Improving access management—
effectively deploying clinic personnel, resources, and processes to achieve timely access—remains a major
challenge nonetheless, especially across widely varying organizational and geographic contexts. Despite their
importance, remarkably little is known about which of these strategies have been implemented, the factors that
support or hinder their use, or their relationship to access metrics.
Specific Aims: To address these gaps, we propose the following specific aims:
Aim 1: To assess national variations in how local VA facilities manage primary care access.
Aim 2: To evaluate how different access management strategies relate to access metrics.
Aim 3: Building on results from Aims 1 and 2, to conduct a national expert panel to come to consensus on
evidence-based practice and policy recommendations to improve access to care.
Methods: For Aim 1, we propose to use key informant-based organizational surveys to assess implementation
of access management strategies on a national basis. We will examine area and organizational determinants
of their uptake, use and implementation by linking resulting survey data with Area Resource File measures
(e.g., urban/rural, primary care shortage area), facility characteristics (e.g., complexity, academic affiliation),
and other organizational measures (e.g., PACT Implementation Index). For Aim 2, we will then link data from
Aim 1 to VHA access metrics, including both administrative (e.g., appointment wait times) and patient-reported
access measures (e.g., obtained care when needed). For Aim 3, we will use modified Delphi panel techniques
to bring together VA and non-VA experts in access management, primary care, care coordination and other
areas to generate evidence-based recommendations based on data from Aims 1 and 2.
Anticipated Impacts on Veterans' Healthcare: The proposed study will provide critical information for VA
leadership to better understand which access mana...

## Key facts

- **NIH application ID:** 10091303
- **Project number:** 5I01HX002678-02
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Danielle Elise Rose
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-01-01 → 2023-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10091303

## Citation

> US National Institutes of Health, RePORTER application 10091303, Impacts of Organizational Variations on Access Management (5I01HX002678-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10091303. Licensed CC0.

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