Title : Enhancing VetRide data quality within the VA to identify transportation barriers among rural veterans
Abstract:
Background: Transportation is a major barrier for many rural Veterans Accessing VA health care, with a third of Veterans living in rural areas. Transportation issues can lead to missed appointments, adverse health outcomes, and potentially higher VA costs. The Veterans Transportation Program (VTP) and Veterans Transportation Service (VTS) manage transportation scheduling and tracking through a program called VetRide. At Asheville VTS, 56% of rides are cancelled weekly and only 56% of these document a reason. Improving data quality on ride cancellations is essential to addressing transportation barriers and enhancing Veterans’ access to care.
Aims: 1) Improve vetride data accuracy for identifying trip cancellation reasons
2) Refine roles and responsibilities of VTS coordinators and third-party vendors in documentation
3) Achieve and sustain >90% documentation of cancellations reasons within 90 days.
Methods: An interprofessional team applied a Lean-Six Sigma quality improvement approach, including creating a fishbone diagram, process mapping, conducting interviews and gemba walks with Asheville VTS, VTP, and VetRide program managers. Interventions consisted of two Plan-Do-Study-Act (PDSA) cycles: Cycle 1: A drop-down menu with pre-selected cancellation reasons was introduced in VetRide. Cycle 2: Choosing a pre-selected reason to be mandatory for trip cancellations for both VTS and third-party vendors. Main outcome measure was defined as the weekly percentage of cancelled trips with complete documentation of reasons. Baseline data was collected for 6 months and for 90 days post-intervention. Statistical process control chart was used to measure data over time. Balancing measures including increased workload or reduced compliance were evaluated through user feedback.
Results: Fishbone diagram, process mapping, and gemba walk revealed optional cancellation reason fields contributed to incomplete data and obscured understanding barriers to care. PDSA cycles were associated with an increase in documentation rates from 56% to 99% over a 90-day period, with the p-chart demonstrating special cause variation and a sustained shift. Balancing measures via user feedback showed no meaningful increase in user burden or decline in workflow adherence.
Conclusion/Impact: Streamlining and mandating documentation of cancellation reasons in VetRide enabled VTS and third-party vendors to achieve and maintain a 99% documentation rate, enhancing data quality with minimal added workload. Higher-fidelity data provides actionable insights to address transportation barriers, inform resource allocation, and potentially reduce missed care or excess costs for the VA. Future initiatives will apply these improvements to better analyze the root causes of transportation barriers, assess access and cost impacts, and design interventions for the Veterans most affected, ultimately improving health care access and outcomes for rural Veterans. Limitations include single-site implementation and limited post-intervention follow-up.
Keywords: Lean-Six Sigma, Transportation, Access
