# Optimizing Specialty Care Access for Veterans with End-Stage Organ Diseases

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2026 · —

## Abstract

Background: Low rates of referral to specialty care among Veterans represent a significant barrier to access
and optimal clinical outcomes. This is particularly true for Veterans with end-stage organ diseases (e.g.,
advanced chronic kidney disease (CKD), decompensated cirrhosis), who are potentially eligible for life-saving
transplantation and require specialty care for optimal disease management. Despite the high prevalence of
end-stage liver and kidney diseases among Veterans, less than a third of Veterans with advanced CKD and
decompensated cirrhosis are referred to a specialist and <5% for transplant evaluation. A comprehensive
assessment of patient-, provider- and system-level factors influencing specialty care referral and referral for
transplant evaluation is critical to developing targeted strategies and approaches to optimize referral
appropriateness as there is a clear association between being seen by a specialist and improved survival.
Significance/Impact: Ensuring timely access to high-quality primary and specialty care is a core mission of
the Veterans Health Administration (VHA). Factors affecting specialty care referral and referral for transplant
evaluation among Veterans with advanced chronic liver and kidney diseases are incompletely characterized.
This knowledge is critical to designing effective strategies to enhance referral appropriateness and optimize
access. Hence, there is an urgent unmet need to improve our understanding of these complex relationships
and the mechanisms by which they affect referral to specialty care and referral for transplant evaluation.
Innovation: Most existing work has focused on steps downstream of referral to specialty care and for
transplant evaluation, such as completion of transplant evaluation, waitlisting, transplant receipt, and post-
transplant outcomes -- thus, barriers to specialty care referral and referral for transplant evaluation remain
understudied. This study will comprehensively examine and identify 

## Key facts

- **NIH application ID:** 11220698
- **Project number:** 5I01HX003658-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Megan Adkins Adams; PRATIMA  SHARMA
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2026
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-10-01T00:00:00 → 2027-09-30T00:00:00

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11220698

## Citation

> US National Institutes of Health, RePORTER application 11220698, Optimizing Specialty Care Access for Veterans with End-Stage Organ Diseases (5I01HX003658-03). Retrieved via AI Analytics 2026-05-17 from https://api.ai-analytics.org/grant/nih/11220698. Licensed CC0.

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