# Patient Experience of Specialty Care Coordination under the MISSION Act

> **NIH VA I01** · EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL · 2024 · —

## Abstract

Background. The MISSION Act incurs unprecedented challenges to care coordination due to greater use of
community care (CC). Yet VA lacks data on patients' experience of coordination, which hinders improvement
efforts. This prospective survey study focuses on VA primary care patients with common chronic medical
conditions that require care coordination [diabetes, congestive heart failure (CHF), and chronic obstructive
pulmonary disease (COPD)]. It will compare patients' experience of specialty care coordination with VA vs. CC,
examine how patients' and clinicians' experiences of coordination relate, and examine the association of
patients' experience of coordination to important outcomes.
Significance. This project addresses HSR&D priority: MISSION Act, coordination of VA and non-VA care. It
will examine how coordination, as experienced by Veterans, relates to both antecedents and outcomes in VA
and CC. These data are novel, important to VA's mission to ensure high quality care within VA and for CC, and
will be actionable by operational partners while advancing the science of care coordination.
Innovation. The surveys measure specialty care coordination directly, i.e. as experienced, by the three main
stakeholders (“triad”) in specialty care coordination: patient, PCP and specialist. Direct assessment of
coordination (rather than of satisfaction) provides specific, actionable information about what needs to improve.
The triad approach permits comprehensive assessment by those who most directly experience the effects of
efforts organize care. It also enables us to examine how stakeholder experiences inter-relate.
Specific Aims.
AIM 1. Compare patients' overall experience of coordination in VA vs. CC.
 H1a. Scores for overall coordination will be better in VA vs CC.
 H1b. The gap in coordination scores for high- vs. low-complexity patients will be less in VA vs. CC.
AIM 2. Examine how patients' overall experience of coordination correlates with those of PCPs and specialists.
 H2a. In VA, patients' scores for overall experience will correlate most strongly with scale scores for PCPs
and specialists on clarity and agreement on roles and responsibilities.
 H2b. In CC, patients' scores for overall experience will correlate most strongly with the scale scores for
PCPs and specialists that measure adequacy of data transfer.
AIM 3. Examine the association of patients' overall experience of coordination with selected outcomes: test
duplication, medication problems, A1C control (in diabetes), self-efficacy, and patient satisfaction.
 H3a. Each outcome is better in VA vs. CC.
 H3b. Better coordination as experienced by patients is associated with fewer duplicated tests and
 medication problems, and better A1C control (in diabetes), self-efficacy, and patient satisfaction.
Methodology. VA primary care patients with referrals to VA or CC specialty care for diabetes, CHF, or COPD
will be included. Clinicians of patient survey respondents will be included. ...

## Key facts

- **NIH application ID:** 10910992
- **Project number:** 5I01HX003309-03
- **Recipient organization:** EDITH NOURSE  ROGERS MEMORIAL VETERANS HOSPITAL
- **Principal Investigator:** Varsha Vimalananda
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-06-01 → 2025-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10910992

## Citation

> US National Institutes of Health, RePORTER application 10910992, Patient Experience of Specialty Care Coordination under the MISSION Act (5I01HX003309-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10910992. Licensed CC0.

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