Are Patients Satisfied with Care in the Veterans Health Administration System?




Budzi, Dorothy F.


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Budzi, Dorothy F., Are Patients Satisfied with Care in the Veterans Health Administration System? Doctor or Public Health (Social and Behavioral Sciences), October 2007, 152 pp, 9 tables, 66 figures, 107 reference, 45 titles. Over 5 million men and women of the U.S. armed forces receive care from the Veterans Affairs healthcare system. The Veterans Health Administration (VHA) is the largest healthcare system and the single largest employer of physician assistants (PAs) and nurse practitioners (NPs) in the United States. Research question: This study asks the question whether the utilization of PAs and NPs in the VHA is a satisfying experience for the patients. Methods: The study analyzed outpatient Survey of Healthcare Experiences of Patients (SHEP), a monthly survey that measures patient satisfaction with the VA healthcare system. Returned surveys of patients who completed their visits at VHA outpatient clinics, acute care centers, and primary care centers across the nation in 2002-2006 were analyzed to explain patients’ satisfaction with PAs, NPs, and physicians. Samplings: Of the 2,164,559 questionnaires that were mailed to patients, 1,601,828 were returned (response rate= 64%, P-value=.05, confidence interval=95%, margin of error +/-2.2). A difference of four or more points is statistically greater than could be caused by sampling error. Secondary data on primary care patient satisfaction scores per Veterans Integrated Network Service (VISN) and facility was analyzed, and compared with provider type ratio per VISN and per facility. Results: the study found that the utilization of non-physician clinicians such as PAs and NPs in the VHA system was a satisfying experience for patients. In certain VISNs, patient satisfaction scores increased by 5% when the number of non-physician clinicians (NPC) was increased compared to 1.8% when the number of physicians was increased. Physician to PA/NP ratio was 7:3, and majority of the primary care providers were male while most of the NPs were female. The dominant age group of the providers was 45-54 years of age. Considering veteran status, PA veteran and non-veteran were 50:50, NP veterans approximately 65%, NP non-veterans 45%, and physician veterans 20% to 80% non-veterans. The information gained from this research may permit the administrators to develop plans and adjustments that foster quality healthcare services.