Veterans Health Administration Employees Research Articles

The Impact of Involvement in Whole Health System for Veterans or Participating in It for Oneself on Job Attitudes in VA Employees.

The aim of the study is to examine how involvement in the Whole Health System of care, clinically and personally (through employee-focused activities), would affect employee satisfaction, engagement, burnout, and turnover intent in the Veterans Health Administration. Multivariate logistic regression analysis of cross-sectional survey from Veterans Health Administration employees was used to determine the influence of Whole Health System involvement and Employee Whole Health participation on job attitudes. Whole Health System involvement was associated higher job satisfaction, higher levels of engagement, lower burnout, and lower turnover intent. A similar pattern of results was identified when looking specifically at Employee Whole Health participation and associated job attitudes. Employees who are either directly involved in delivering Whole Health services to veterans or who have participated in Whole Health programming for their own benefit may experience a meaningful positive impact on their well-being and how they experience the workplace.

Administration’s Share of Personnel in Veterans Health Administration and Private Sector Care

Health care administrative overhead is greater in the US than some other nations but has not been assessed in the Veterans Health Administration (VHA). To compare administrative staffing patterns in the VHA and private (non-VHA) sectors. This cross-sectional study was conducted using US employment data from 2019, prior to pandemic-related disruptions in health care staffing, and was carried out between January 14 and August 10, 2023. A nationally representative sample of federal and nonfederal personnel in hospitals and ambulatory care settings from the American Community Survey (ACS), all employees reported in VHA personnel records, and personnel in health insurance carriers and brokers tabulated by the Bureau of Labor Statistics (BLS) were analyzed. VHA vs private sector health care employment, including 397 occupations grouped into 18 categories. The proportion of staff working in administrative occupations. Among 3 239 553 persons surveyed in the ACS, 122 315 individuals (weighted population, 12 501 185 individuals) were civilians working in hospitals or ambulatory care; of the weighted population, 12 156 988 individuals (mean age, 42.6 years [95% CI, 42.5-42.7 years]; 76.2% [95% CI, 75.9%-76.5%] females) were private sector personnel and 344 197 individuals (mean age, 46.2 years [95% CI, 45.7-46.7 years]; 63.8% [95% CI, 61.8%-65.8%] females) were federal employees. In clinical settings, administrative occupations accounted for 23.4% (95% CI, 23.1%-23.8%) of private sector vs 19.8% (95% CI, 18.1%-21.4%) of VHA personnel. After including 1 000 800 employees at private sector health insurers and brokers and 13 956 VHA Central Office personnel with administrative occupations, administration accounted for 3 851 374 of 13 157 788 private sector employees (29.3%) vs 77 500 of 343 721 VHA employees (22.5%). Physicians represented approximately 7% of personnel in the VHA (7.2% [95% CI, 6.1%-8.2%]) and private sector (6.5% [95% CI, 6.3%-6.7%]), while the VHA deployed more registered nurses (23.7% [95% CI, 21.6%-25.8%] vs 21.2% [95% CI, 20.9%-21.5%]) and social service personnel (6.3% [95% CI, 5.4%-7.1%] vs 4.9% [95% CI, 4.7%-5.0%]) than the private sector. In this study, administrative occupations accounted for a smaller share of personnel in the VHA compared with private sector care, a difference possibly attributable to the VHA's simpler financing system. These findings suggest that if staffing patterns in the private sector mirrored those of the VHA, nearly 900 000 fewer administrative staff might be needed.

Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE): Initial Evaluation of the Clinical Effects of RISE Administered in Routine Care in the US Veterans Health Administration

Intimate partner violence (IPV) is a common concern among military Veterans that negatively impacts health. The United States’ Veterans Health Administration (VHA) has launched a national IPV Assistance Program (IPVAP) to provide comprehensive services to Veterans, their families and caregivers, and VHA employees who use or experience IPV. Grounded in a holistic, Veteran-centered psychosocial rehabilitation framework that guides all facets of the program, the IPVAP initiated the pilot implementation of a novel intervention called Recovering from IPV through Strengths and Empowerment (RISE). This evidence-based, person-centered, trauma-informed, and empowerment-oriented brief counseling intervention is designed to support those who experience IPV and to improve their psychosocial wellbeing. This program evaluation study describes clinical outcomes from patients who participated in a pilot implementation of RISE in routine care. We examined changes in general self-efficacy, depression, and valued living, as well as treatment satisfaction among patients who received RISE and completed program evaluation measures at VHA facilities during the pilot. Results from 45 patients (84% women) indicate that RISE was associated with significant pretreatment to posttreatment improvements in self-efficacy, depression, and valued living (Cohen’s d s of 0.97, 1.09, and 0.51, respectively). Patients reported high satisfaction with treatment. Though preliminary results were similar across gender and IPV types, findings from the evaluation of the pilot implementation of RISE demonstrate the intervention’s feasibility, acceptability, and clinical utility in routine VHA care and inform the scalability of RISE. Additionally, findings provide preliminary support for the effectiveness and acceptability of RISE with men. Modification to RISE and its implementation are discussed, which may be useful to other settings implementing IPV interventions.

Barriers to Community Treatment for Opioid Use Disorders among Rural Veterans

The Veterans Health Administration (VHA) has instituted several national initiatives to increase access to medication for opioid use disorder (MOUD). throughout rural America. The expansion of the MISSON Act’s community care model may prove beneficial, but barriers still constrain widespread community treatment for veterans. The present study illuminates several previously unidentified barriers facing community-based providers who aim to provide MOUD to rural veterans. The primary means of data collection for this study included in-depth interviews with fifty-three non-VHA MOUD providers, thirty-one staff at non-VHA community-based organizations serving veterans, and five VHA behavioral health employees affiliated with the Montana VHA’s substance use disorder program. Staff at non-VHA community-based organizations serving veterans refer veterans to the VHA for MOUD and express a low literacy level about non-VHA MOUD providers. VHA employees favor the VHA for MOUD and lack a network of collaboration with providers at non-VHA community care clinics. Attitudinal and structural barriers constrain veterans’ treatment options within community settings by creating a vacuum of care in the community, whereby all veterans are funneled to the VHA for MOUD. In Montana, only 6 veterans receive MOUD from non-VHA providers, and this reliance on the VHA’s MOUD program constrains access to treatment and the quality-of-care veterans receive.

Characteristics and Practice Patterns of U.S. Veterans Health Administration Doctors of Chiropractic: A Cross-sectional Survey

ObjectiveThe purpose of this study was to survey U.S. Veterans Health Administration (VA) chiropractors to assess current demographic and professional characteristics, including practice parameters, interprofessional collaboration, academic experience, and scholarly activity. MethodsA cross-sectional survey was performed from August 21, 2019, to September 6, 2019, including all chiropractors identified with any VA appointment. REDCap software was used to conduct the survey. Data from surveys were exported to Microsoft Excel for data analysis. ResultsOf the 177 providers solicited, 118 returned completed surveys (67% response rate). Respondents predominantly self-reported as white (84%) and male (77.1%), with a mean age of 47 years, and reported spending at least 75% of time on clinical care. Most respondents reported being VA employees (96%) with full-time appointments (94%). Approximately half reported having prior hospital training (48%), supervising chiropractic students (53%) and students in other health professions (47%), and authoring or coauthoring ≥1 peer-reviewed publications (42%). Respondents reported performing an average of 6 to 15 new-patient consultations and 31 to 60 follow-up visits per week. Most patient referrals to chiropractic care originated from primary care providers, with low back conditions without radiculopathy as the most frequently seen condition. Diversified manipulation and flexion-distraction techniques, along with myofascial therapies, therapeutic exercises, and self-management advice, were the most commonly reported interventions. ConclusionWe report provider and practice characteristics from chiropractors working in a large, integrated health care system. Most are full-time employees, work in physical medicine departments, and have held their position for up to 5 years. The majority of respondents report diagnostic and treatment approaches concordant with current clinical practice guidelines.

Clinician Wellness—Self-Care for Staying Healthy: Implementation of a Wellness Calendar and Programming for Health Care Workers in Response to COVID-19

Clinician Wellness—Self-Care for Staying Healthy: Implementation of a Wellness Calendar and Programming for Health Care Workers in Response to COVID-19

Teamness, burnout, job satisfaction and decision-making in the VA Centers of Excellence in Primary Care Education

Abstract Background/purpose To evaluate teamness perceptions of employees and trainees and associations between teamness and employee perceptions of burnout, satisfaction, and decision-making in the context of a clinical setting with interprofessional trainees. Methods Seven Veterans Health Administration (VA)-funded Centers of Excellence in Primary Care Education (CoEPCE) developed interprofessional ambulatory learning environments. Two hundred forty-eight trainees and 260 employees completed the Assessment for Collaborative Environments (ACE-15) scale, a measure of teamness; VA employees also answered survey questions on burnout, job satisfaction, and decision-making. Means, standard deviations, t-tests, analysis of variance (ANOVA) using Levene's test for homogeneity and Pearson's product-moment correlations were performed. Data were collected in each of two years. Results For employees, higher teamness was correlated with lower burnout, higher satisfaction, and higher decision-making in both years. In Year 1, employee mean ACE-15 score was 46.86 (SD 7.44) and trainee mean was 50.22 (SD 5.81). In year 2, the employee mean was 47.08 (SD 6.16) and trainee mean was 50.47 (SD 6.16) (p Conclusions We found that teamness was significantly higher in trainees than employees in both years, and that the ACE-15 was effective in discriminating between these groups. The ACE-15 is helpful in measuring teamness in a primary care education reform context, and correlates with employee improvements in burnout, satisfaction, and decision-making. This study suggests that, in a context of interprofessional learning, measuring teamness among all care team members can enhance understanding of what influences performance and satisfaction.

Examining burnout profiles in relation to health and well-being in the Veterans Health Administration employee population.

The goals of this paper were twofold: (a) To provide a population overview of burnout profiles by occupation in a large, health care sector employee population and (b) to investigate how burnout profiles relate to self-reported health behaviours, chronic conditions, and absenteeism. Burnout profiles were considered by 5 main occupational groups (physicians, nurses, other clinical, administrative, and wage grade [trade, craft, and labor workers]) in survey respondents (n=86,257 employees). Logistic regression analyses were conducted to examine how burnout profiles were associated with health controlling for gender, age, race, ethnicity, and occupational group. Employees in the "Frustrated/Burning Up" and "Withdrawing/Burned Out" profiles, respectively, had significantly increased odds of anxiety (OR=2.17; 99% CI [2.04, 2.31]; OR=2.21; 99% CI [2.05, 2.38]), depression (OR=2.06; 99% CI [1.93, 2.20]; OR=2.20; 99% CI [2.04, 2.38]), sleep disorders (OR=1.98; 99% CI [1.85, 2.12]; OR=1.97; 99% CI [1.81, 2.13]), low back disease (OR=1.60; 99% CI [1.50, 1.71]; OR=1.58; 99% CI [1.47, 1.70]), physical inactivity (OR=1.49; 99% CI [1.38, 1.60]; OR=1.68; 99% CI [1.54, 1.83]), and 5 or more days away from work (OR=1.74; 99% CI [1.65, 1.85]; OR=2.15; 99% CI [2.01, 2.30]). Burnout is related to the health of employees. Burnout profiles offer a way to assess patterns of burnout by occupational group and may help customize future interventions.

Decreasing Physical Inactivity in the Veterans Health Administration Employee Population.

The aim of this study was to describe a comprehensive approach to decrease physical inactivity in the Veterans Health Administration (VHA) employee population. The approach included (1) initiatives to decrease physical inactivity in the workplace; (2) two operational surveys to assess system-wide service provision; and (3) two national employee surveys. From 2010 to 2012, 86 employee fitness centers were completed in VA medical centers. A grants program (2010 to 2015) funded smaller projects designed to decrease physical inactivity in the workplace. Projects involved the provision of equipment to decrease sedentary behaviors, including stability balls, treadmill and sit-to-stand desks, stairwell projects, and funding for on-site fitness classes, bicycle racks, and outdoor par courses and walking paths among others. A comprehensive approach to decrease physical inactivity in VHA employees was successful. Overall, self-reported, age-adjusted physical inactivity in VHA employees decreased from 25.3% in 2010 to 16.1% in 2015.

Evaluation of safety climate and employee injury rates in healthcare

ObjectivesSafety climates that support safety-related behaviour are associated with fewer work-related injuries, and prior research in industry suggests that safety knowledge and motivation are strongly related to safety performance behaviours;...

How Do Healthcare Employees Rate the Ethics of Their Organization? An Analysis Based on VA IntegratedEthics® Staff Survey Data

Healthcare organizations with an ethical culture experience higher levels of employee productivity, less staff turnover, better levels of patient safety, resource and cost savings, and higher levels of patient satisfaction. Employees' perceptions of the ethics of their organization are considered a good indicator of the ethics culture. How employees rate the ethics of their organization is not well understood. Previous research has identified a number of attributes that are salient to employees' perceptions in this area. However, little is known about how employees synthesize their perceptions of these attributes to rate the ethics of their organization. Without this knowledge, managers have little specific information to act on to improve practices that would in turn improve employees' perceptions of their organization's ethics. For this study, we used data from Department of Veterans Affairs' (VA) 2014 IntegratedEthics@ Staff Survey administered to Veterans Health Administration (VHA) staff. We used multivariate regression analyses to investigate how VHA employees weigh their perceptions of eight attributes of an ethical organization to inform an overall rating of the ethics of their organization. We found that employee perceptions of fairness, clarity of expectations, accountability, and leadership's prioritization of ethics had the strongest associations with the overall rating. In addition, employees disproportionately weighed their positive perceptions in determining their overall rating. Therefore, a strategy to improve employees' perceptions of these attributes could potentially have the greatest marginal return on investment with respect to improving employees' perceptions of the ethics of an organization.

Psychological Safety and Error Reporting Within Veterans Health Administration Hospitals

In psychologically safe workplaces, employees feel comfortable taking interpersonal risks, such as pointing out errors. Previous research suggested that psychologically safe climate optimizes organizational outcomes. We evaluated psychological safety levels in Veterans Health Administration (VHA) hospitals and assessed their relationship to employee willingness of reporting medical errors. We conducted an ANOVA on psychological safety scores from a VHA employees census survey (n = 185,879), assessing variability of means across racial and supervisory levels. We examined organizational climate assessment interviews (n = 374) evaluating how many employees asserted willingness to report errors (or not) and their stated reasons. Finally, based on survey data, we identified 2 (psychologically safe versus unsafe) hospitals and compared their number of employees who would be willing/unwilling to report an error. Psychological safety increased with supervisory level (P < 0.001, η = 0.03) and was not meaningfully related to race (P < 0.001, η = 0.003). Twelve percent of employees would not report an error; retaliation fear was the most commonly mentioned deterrent. Furthermore, employees at the psychologically unsafe hospital (71% would report, 13% would not) were less willing to report an error than at the psychologically safe hospital (91% would, 0% would not). A substantial minority would not report an error and were willing to admit so in a private interview setting. Their stated reasons as well as higher psychological safety means for supervisory employees both suggest power as an important determinant. Intentions to report were associated with psychological safety, strongly suggesting this climate aspect as instrumental to improving patient safety and reducing costs.

Advanced radiation oncology technology within the Veterans Health Administration (VHA).

52 Background: The rapid evolution of technology in the treatment of cancer has paralleled other technological advancements in modern society. Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Brachytherapy (BT), Cone Beam Computed Tomography (CBCT), Stereotactic Radiosurgery (SRS), and Stereotactic Body Radiotherapy (SBRT) facilitate treatment with higher, more conformal radiation doses, potentially improving cancer control while reducing normal tissue toxicity. Recent Surveillance, Epidemiology and End Results (SEER) program data and physician surveys indicate prostate BT is declining and the integration of SRS and SBRT is slower compared to IMRT. As utilization of technology increases, an understanding of its availability within the VHA is necessary to ensure quality and patient safety. Methods: An electronic survey was sent to 82 Radiation Oncologists (ROs)at 38 active VHA Radiation Oncology Centers with subsequent follow-up phone calls. The survey occurred from May-June 2014. ROs were queried on the availability of advanced RT technologies including IMRT, IGRT, BT, CBCT, SRS and SBRT at their facility. Practitioner specific details: years in practice, academic appointment and VHA employment status were collected. Results: Responses were obtained from 62 ROs representing 75% of VHA ROs and 34 or 89% of facilities. Full time VHA employees made up 60% of respondents with 35% in practice for &lt;5 years and 34% practicing for &gt;20 years; 71% held an academic appointment. The Table shows on site availability of advanced RT technologies within the 34 VHA sites that responded. Conclusions: For veterans receiving cancer treatment, VHA ROs are able to routinely use IMRT and IGRT with CBCT capabilities. However, stereotactic (SRS and SBRT) and BT services are less available, and may require referrals externally or to other VHA facilities. Limited availability of SRS and SBRT parallels the community experience. Likewise the decreasing utilization of BT is common to the VHA and private sector. SBRT, SRS and BT require significant expertise and technology. [Table: see text]

White House Hosts Briefing on Federal Suicide Prevention Efforts

Back to table of contents Previous article Next article Professional NewsFull AccessWhite House Hosts Briefing on Federal Suicide Prevention EffortsMark MoranMark MoranSearch for more papers by this authorPublished Online:16 Oct 2014https://doi.org/10.1176/appi.pn.2014.10b27AbstractAPA Trustee-at-Large Anita Everett, M.D., representing APA at the briefing, says that meaningfully addressing suicide prevention requires involvement beyond traditional clinical settings.Suicide and suicide prevention were the focus of a widely attended briefing at the White House last month. Participants outlined federal initiatives and partnerships among agencies devoted to health care, mental health, law enforcement, veterans affairs, and the military.Anita Everett, M.D., says that reducing deaths by suicide requires solutions beyond the clinical setting.David HathcoxRepresenting APA at the event was Trustee-at-Large Anita Everett, M.D., who told Psychiatric News that the federal focus on suicide is a welcome development for psychiatrists and their patients. “Suicide is a common component in a day in the life of a practicing psychiatrist,” she said. “We are experienced with the management of suicidal ideation and plans for those who make it into our offices and services. Suicide, however, is a much more common phenomenon within our whole population, and very few of the persons who have serious suicidal ideation actually make it into the offices of psychiatrists or other mental health professionals. “We see only a small portion of those who are at risk for suicide, and meaningfully addressing our national suicide rate requires involvement beyond traditional clinical settings,” she said. “We need a population approach that includes elements of prevention, early intervention, and increasing access to treatment.” At the event, Francis Collins, M.D., director of the National Institutes of Health, outlined the scope of suicide: 39,000 lives lost each year to suicide in the United States, 800,000 worldwide. Collins said NIH was spending $2 billion a year on mental health and $60 million on suicide prevention. He said the President’s BRAIN Initiative will provide further insight into brain circuitry to develop better medications to treat depression and schizophrenia, improve diagnosis of depression, and look at ways to deliver faster-working treatments. Pamela Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), outlined SAMHSA activities with regard to suicide including the Garrett Lee Smith Suicide Prevention Funds, grants to Native-American tribes for suicide prevention, and the “Your Life Matters” program, a SAMHSA initiative launched with faith communities. Hyde also said that states must submit suicide prevention strategies as part of their federal grant requests. Caitlin Thompson, Ph.D., deputy director of the Suicide Prevention Program at the Veterans Administration (VA), noted that 20 percent of people who die by suicide are veterans. She said there are 700 VA employees working on suicide prevention, 300 of whom are assigned to crisis lines, and there are 300 suicide prevention coordinators at VA facilities nationwide. She added that the VA is expanding its suicide prevention and intervention training to all Veterans Health Administration employees and is working with the Department of Defense on a firearms safety program.“As psychiatrists, we know that suicide impacts virtually everyone, particularly the family and close friends of those left behind,” Everett told Psychiatric News. “We know that we cannot accurately predict which of our patients with suicidal thoughts will go on to attempt suicide.” But Everett noted that there are now more advanced tools—especially the Columbia-Suicide Severity Scale, developed by the Columbia University Suicide Risk Assessment Center—to help reliably stratify risks and proactively manage suicidal ideation in clinical settings.She said the broad array of projects outlined at the White House was heartening. “The initiatives outlined at this briefing will be far reaching in their impact on our nation’s suicide crisis,” she said. ■More information on the Obama administration’s suicide-prevention initiatives can be accessed here. ISSUES NewArchived

Demographic Question Placement: Effect on Item Response Rates and Means of a Veterans Health Administration Survey

Purpose This study examined whether demographic question placement affects demographic and non-demographic question completion rates, non-demographic item means, and blank questionnaire rates using a web-based survey of Veterans Health Administration employees.

Disparities in Health Behaviors and Chronic Conditions in Health Care Providers in the Veterans Health Administration

To determine baseline prevalence of health behaviors and chronic health conditions in Veterans Health Administration (VHA) employees and highlight disparities by occupation group. There were 29,834 responses to the survey. Age-standardized prevalence estimates for VHA employees were compared to national estimates from BRFSS surveys. The VHA estimates were analyzed for physicians and dentists; physician assistants and nurse practitioners; registered nurses; licensed practical nurses and nursing assistants; other clinical; nonclinical; and wage grade staff. Multilevel regression explored the effect of worksite. The VHA employees have higher rates of unhealthy behaviors and chronic health conditions than US adults, except for smoking. Results illustrated significant disparities between occupation groups by demographics and variability by worksite. Veterans Health Administration's population appears less healthy than the US general population. Disparities between occupation groups support the establishment of targeted health promotion programs, with attention paid to differences in local culture.

2009 Influenza Pandemic Impact on Sick Leave Use in the Veterans Health Administration: Framework for a Health Care Provider–Based National Syndromic Surveillance System

To determine relations between sick leave use and the 2009 novel influenza A (H1N1) influenza pandemic among clinical and nonclinical staff in the Veterans Health Administration (VHA). Aggregate sick leave use for all VHA employees was monitored in near-real time during the 2009 H1N1 influenza pandemic and compared with historical data from 2004 to 2008. The ratio of sick leave use between clinical and nonclinical staff was examined. An autoregressive integrated moving average model was used to assess whether the pandemic had a significant effect on sick leave use. The H1N1 influenza pandemic was associated with a significant effect on sick leave use in the VHA during the second wave of the pandemic. During this wave, the ratio of clinical to nonclinical sick leave use changed; clinical staff began taking more leave than nonclinical staff for 3 successive 2-week pay periods, with ratio measures of 1.004, 1.018, and 1.011, respectively. Using an autoregressive integrated moving average model with a pulse variable representing the pandemic, there was a significant effect on sick leave use. The average hours of sick leave used per full-time equivalent staff member per month increased by 0.3904 hours (P = .003) for clinical staff and 0.3898 hours (P = .01) for nonclinical staff over previous months during the first month of the second pandemic wave. Work loss associated with a pandemic is an important indicator of disease activity and may be a more sensitive indicator of emerging strains than deaths. Monitoring sick leave use in near real time in a large national health care system may be an important early indicator of pandemic severity with practical implications that should be considered in addition to more traditional measures of influenza epidemic and pandemic severity.

Comparing Safety Climate between Two Populations of Hospitals in the United States

To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting. Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals. Cross-sectional study of 69 U.S. and 30 VA hospitals. For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca-Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples. The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: -0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics. Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities.

Characteristics of Veterans Health Administration chiropractors and chiropractic clinics

Chiropractic services have been delivered on station at select Veterans Health Administration (VHA) medical facilities since late 2004. No published data describing the characteristics of VHA chiropractic physicians (chiropractors) and chiropractic clinics exist at a national level. This study was designed to examine elements of the structures of chiropractic services in VHA settings. Web-based survey methods were used to question all chiropractors in VHA facilities (N = 36). Data were obtained from 33 providers, yielding a 91.6% response rate. Most respondents were full-time VHA employees, while others were part-time employees or contractors. Differences were found in prior training, integrated practice, and academic or research experience. Of the respondents, 88% ranked low back pain as the most common patient complaint seen in practice and 79% ranked cervical pain the second most common complaint. Of the new patient consultations, 67.6% originated from primary care, 9.4% from pain management, and 6.2% from physiatry. Most respondents were similar in their reported use of diagnostic and therapeutic procedures, but their reported rates of participation in various facility activities were different. Further work is needed for researchers and policy makers to more fully understand the integration and delivery of chiropractic services in VHA settings.

Overcoming challenges to successful interagency collaboration

The Veterans Health Administration Employee Education System has launched a collaborative effort with its counterpart agencies in the U.S. Air Force, Army, Coast Guard, and Navy to develop reusable training content applicable to multiple federal agencies. The goal is to combine interagency resources to create healthcare–related training courseware that all participating agencies can share. The success of this initiative is attributable to the willing and deliberate, cooperative efforts of these agencies. Here, we discuss 17 challenges to collaborative training development.