Care in the Community Healthcare Inspection of VA Heartland Network (VISN 15)

The Office of Inspector General (OIG) Care in the Community healthcare inspection program examines clinical and administrative processes associated with providing quality outpatient healthcare to veterans. This report provides a focused evaluation of Veterans Integrated Service Network (VISN) 15 and its oversight of the quality of care delivered in community-based outpatient clinics (CBOCs) and through its community care referrals to non-VA providers. Although it is difficult to measure the value of well-delivered and coordinated care between VA and non-VA providers, the findings in this report may help VISN leaders identify vulnerable areas of community care that, if properly addressed, should improve healthcare quality for veterans. The OIG reviewed care coordination: congestive heart failure management; primary care and mental health (diagnostic evaluations following positive screenings for depression or alcohol misuse); quality of care (home dialysis care); and women’s health (mammography care and communication of results). The OIG issued three recommendations for improvement in one area, quality of care: • Ensuring an end-stage renal disease provider sees patients in the home dialysis program at least monthly, as evidenced by a progress note in the medical record by the responsible independent renal practitioner • Performing initial and annual home visits for patients accepted into the VISN 15 home dialysis program • Monitoring the quality of home dialysis contracted clinical services for patients receiving non-VA home dialysis services