A Referral Program for Hawai‘i-Based Reservists to Improve Access to Care.

Abstract

Since the declaration of the Global War on Terror (GWOT) in 2001, 269 Hawaii-based Navy Reservists deployed to combat zones in support of combat operations. Upon completion of activated duty, Hawaii-based Navy Reservists report to the Veterans Affair (VA) for post deployment assessment and care. To date, there is no structured process for Hawaii-based Navy Reservist Veterans to gain access into the VA Pacific Islands Health Care System (VAPIHCS). This project was guided by the Stevens Star Model of Knowledge Transformation; a literature synthesis indicated implementing a referral process would improve access to care. The Referral Program was an evidenced-based, quality improvement (QI), patient-centered program and consisted of two phases: (1) Phase I: design and develop an algorithm and referral trifold pamphlet regarding the VAPIHCS enrollment process; and (2) Phase II: implement the referral process by healthcare providers during the Periodic Health Assessment (PHA) appointments for Hawaii-based Navy Reservists, at Pearl Harbor, HI. Data analysis consisted of evaluation of training regarding compliance with the referral process and assessment of provider satisfaction with the training and process for education of redeploying Veterans. The score for knowledge acquisition by healthcare providers (n = 25) increased from 21 to 47 points out of 60 possible points as a result of the training, demonstrating a 43% increase in knowledge acquisition. However, the providers of OHSU SD DET D integrated the change into practice only 10% of the time during PHA appointments. At the end of the four-month post implementation period, 65% (n = 20) of the providers found the program useful. This project indicates a clear need for an evidence-based referral process to ensure redeploying Reservists are provided information regarding VA healthcare benefit eligibility. This QI project increased the healthcare provider’s knowledge regarding the VAPIHCS enrollment process and provided a referral trifold pamphlet to disseminate information to Veterans, but did little to sustain a practice change. Additional efforts will be needed to ensure healthcare personnel guide Reservists in understanding post deployment healthcare entitlements through the VA.