title: Interventions to improve veterans' access to care: a systematic review of the literature.
abstract: OBJECTIVE
  To conduct a systematic review to address the following key questions: (1) what interventions have been successful in improving access for veterans with reduced health care access? (2) Have interventions that have improved health care access led to improvements in process and clinical outcomes?
  
  
  METHODS
  OVID MEDLINE, CINAHL, PsychINFO.
  
  
  METHODS
  English language articles published in peer-reviewed journals from 1990 to June 2010. All interventions designed to improve access to health care for US veterans that reported the impact of the intervention on perceived (e.g., satisfaction with access) or objective (e.g., travel time, wait time) access were included. APPRAISAL AND SYNTHESIS METHODS: Investigators abstracted data on study design, study quality, intervention, and impact of the intervention on access, process outcomes, and clinical outcomes.
  
  
  RESULTS
  Nineteen articles (16 unique studies) met the inclusion criteria. While there were a small number of studies in support of any one intervention, all showed a positive impact on either perceived or objective measures of access. Implementation of Community Based Outpatient Clinics (n = 5 articles), use of Telemedicine (n = 5 articles), and Primary Care Mental Health Integration (n = 6 articles) improved access. All 16 unique studies reported process outcomes, most often satisfaction with care and utilization. Four studies reported clinical outcomes; three found no differences.
  
  
  CONCLUSIONS
  Included studies were largely of poor to fair methodological quality.
  
  
  CONCLUSIONS
  Interventions can improve access to health care for veterans. Increased access was consistently linked to increased primary care utilization. There was a lack of data regarding the link between access and clinical outcomes; however, the limited data suggest that increased access may not improve clinical outcomes. Future research should focus on the quality and appropriateness of care and clinical outcomes.
authors: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA. Shannon.Kehle@va.gov
authors: Shannon M
authors: SM
authors: Kehle
authors: Nancy
authors: N
authors: Greer
authors: Indulis
authors: I
authors: Rutks
authors: Timothy
authors: T
authors: Wilt
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*; D058014:Veterans Health / Q000592:standards*