Care in the Community Healthcare Inspection of VA Midwest Health Care Network (VISN 23)

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) 23 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 for 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 two areas:(1) Quality of Care• Completing initial and annual home visits for patients accepted into the VISN 23 home dialysis program• Monitoring quality of home dialysis contracted clinical services(2) Women’s Health• Receiving written results from community providers within 30 days of the procedure