Planning rehabilitative service expansion for veterans

Access to rehabilitative services for Veterans living in rural areas is limited as there are significant barriers to care such as shortages of appropriately-trained medical professionals; poor rural infrastructure; and distance between patients and providers. Rurality of Veterans compounds existing barriers to care. Rural Veterans face additional challenges such as lack of specialists in the local community and limited resources to recruit and retain health professionals. Furthermore, the need for increased rehabilitative services is evident as the number of combat-related injuries has increased during the recent extended period of wartime. Also, the demand for such services has been compounded by the growing population of aging Veterans.

The Rehabilitative Service Expansion Program for Veterans aims to improve the quality of care of rural Veterans by eliminating access barriers to care by expanding the reach of the basic rehabilitative services found elsewhere within VA. The Planning Rehabilitative Service Expansion project conducted a baseline assessment of current staffing, equipment, and space capacities of three Community-Based Outreach Clinics (CBOCs). The project conducted a population-based rehabilitative needs assessment, which aimed to identify service gaps in order to deliver the most needed services. The project developed a specific clinic expansion plan, describing the staffing, equipment, space, and services to be offered at the newly proposed clinics, and the clinic expansion plan was executed at two CBOCs. The project also developed a communications and outreach program to disseminate information regarding the new rehabilitative service in VISN 5. In order to evaluate clinic expansions, the team collected data on program metrics relating to cost savings, patient satisfaction, and access, including the number of encounters, number of unique patients seen, and efficiency rates of the providers, which indicates therapist capacity.

Preliminary evidence indicates both strong patient satisfaction and cost avoidance associated with the program. Initial results also highlight a number of challenges including the recruitment of providers in rural areas, integration of new services within existing service provision contracts, and utilization of space and facilities at existing clinics without disrupting current operations. This project makes an important contribution to the health administration knowledge-base in that it is a rare example of an evidence-based, rural-oriented service expansion plan within a large integrated federal health system.