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VHA Community Partnership Challenge

Community Partnership Challenge series: How Veterans Transportation Service prevents missed medical appointments, leading to better health outcomes for Veterans

This is the fifth in a series of articles about how various VA and VHA offices, initiatives, and programs support social determinants of health—the theme of the 2020 VHA Community Partnership Challenge. The fifth Community Partnership Challenge series feature: Veterans Transportation Service.

Veterans Transportation Service (VTS), which provides free door-to-door travel for Veterans to Department of Veterans Affairs (VA) and authorized non-VA health care facilities for medical care, has resulted in better health outcomes for patients, according to a 2018 research study. The reason: Fewer missed medical appointments.

The study, conducted by The MITRE Corporation, found that VA patients who lack transportation were more likely to: visit an emergency department (ED); be admitted to inpatient status from the ED; exhibit higher readmission rates and pain scores; be diagnosed with suicidal ideations, attempted suicide, or intentional self-harm; have lower five-year survival rates for lung cancer and prostate cancer; and more. The study found that more than 250,000 patients who canceled at least one VA appointment in 2017 cited transportation problems as the reason.

Positive social determinants of health (SDOH), such as access to transportation, are so critical to Veterans’ well-being that they are the theme of the Veterans Health Administration (VHA) Community Partnership Challenge, an annual contest hosted by VHA’s Office of Community Engagement (OCE). SDOH are conditions in the environments where Veterans live, learn, play, worship, and age.

Marc Chevalier, field operations manager for the Veterans Transportation Program, which oversees VTS, saw first-hand how a lack of transportation could have damaging effects on Veterans. Motivated to work in mental health services at VA because of the high rate of patient suicide and suicide attempts, the licensed clinical social worker said mental health issues were made worse by Veterans’ family problems and a lack of access to regular medical care. Transportation to appointments was especially a problem for Veterans who had lost their family’s support, he said.

“Being able to have that routine interaction with the therapist is critical, particularly for patients who are dealing with major depressive disorder or posttraumatic stress disorder (PTSD),” he said.

For patients in rural areas, where transportation options are fewer, Veterans who are experiencing a mental health crisis might be transported to a VA medical center by local law enforcement, and possibly in handcuffs. “That does not help their mental health condition any,” he said. “Once that happens, Veterans tend not to call for help again.”

According to the study, patients who were diagnosed with intentional self-harm, attempted suicide, or suicidal ideations who used VTS at least once reduced their appointment cancellation rates by 20%.

With VHA recognizing that lack of transportation was a barrier to care, Mr. Chevalier was invited to serve on a work group that led to the creation of VTS in 2010, and he piloted one of the first VTS programs at VA Muskogee.

Prior to that, Mr. Chevalier said, VA had been transporting Veterans for 25-30 years, “but typically it was very haphazard, unregulated and mostly in the form of shuttles,” which were problematic because Veterans still needed transportation to a pick-up location, and the shuttle vans were restricted to ambulatory patients.

VTS provides funding to participating VA medical centers for a mobility manager, dispatcher, drivers, and Americans with Disabilities Act (ADA)-compliant wheelchair, stretcher, and ambulance vehicles.

“We cover large areas, especially in rural states, such as Montana with one VA medical center in the whole state and with vehicles stationed at all of the VA Community-Based Outpatient Clinics—some as far as 238 miles one way from the medical center” he said. “VTS has collaborated between participating sites to transport Veterans as far as across four states (Ohio to Alabama).”

VTS, which currently operates in 120 VA medical centers, is expanding by adding approximately 10-20 sites by the end of FY21, said Mr. Chevalier. As a result of a VHA directive, all VA medical centers will offer VTS by the end of FY22.

For more information on VTS, please visit: https://www.va.gov/healthbenefits/vtp/veterans_transportation_service.asp

For more information on OCE’s work or to contact OCE for partnership opportunities, please visit: https://www.va.gov/healthpartnerships/.

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Posted June 18, 2020