Engaging Veterans, caregivers, and system stakeholders to improve VA home and community-based services

Objective: To understand Veterans', caregivers', and stakeholders' perceptions of home-based and caregiver support services and their suggestions for improvement to better align services with needs. Data Sources: We identified Veterans and caregivers at four EDCoE sites using the VA high-need, high-risk list, representing Veterans who qualify for home-based primary care. We randomly selected Veterans and their caregivers, stratifying by age. We also identified leaders and clinicians involved in clinical service delivery. Study Design: Between February and November 2019, we conducted in-person and telephone interviews and focus groups using semi-structured questions tailored to each group, analyzing them through a rapid qualitative analysis approach and providing real-time feedback to operational partners. Data Collection: Thirty-four Veterans, 24 caregivers, and 39 leaders and clinicians participated. Principal Findings: Respondents identified key categories of experience that could be monitored and improved, including navigating an increasingly complex system, coordinating and communicating across services, and unmet household and financial needs. Veterans and caregivers described quality in terms of reliability, timeliness, standardization, and accountability. Summaries were created to contextualize results and to highlight gaps and opportunities for new measures and policy development. Conclusions: Collaborating with Veterans, caregivers, and stakeholders enables us to understand their daily experiences and to develop meaningful approaches to evaluating services that incorporate their perspectives. Providing regular, actionable feedback to operational partners informs policy and operational initiatives, such as the scope of services and infrastructure for system navigation.