Table 1 Summary of 4 major themes, illustrative quotes, and recommendations for improving coordination

Frustrations Trying to Navigate the VA Health Care System “Black Box”

“Veterans don’t always know what they’re eligible for. It’s not printed out. You try to find out…I think if it’s hard for us, a veteran who might not be in the best of shape has to leap over hills and mountains, and it’s really tragic. I’m a veteran and I don’t even understand what people are eligible for.”

•“VA 101” training

• In-person meetings between HCH and VA staff

Lack of Clear Lines of Communication with the VA

“Calling the VA, trying to get access to the medical providers to collaborate, or even just get appointments for the veteran is like calling a black hole. You get transferred and transferred and transferred and dropped. It is useless. I just stop taking the time and the effort to do it. I don’t have the time.”

• Clearly defined and transparent channels for phone and email communication

• Transfer of patient-related information between institutions

Caring for Patients without Access to their VA Medical Record

“I think the biggest factor for me is lack of access to the medical record. Many, many times I am seeing people who want to establish primary care with us, but they’ve previously gone to the VA. Trying to get their health maintenance up to date with immunizations and colonoscopies etc. is so, so, difficult. I can easily place an order for a colonoscopy and get that scheduled, but they say, ‘Oh, I had one last year, but I’m not sure of the results.’”

• Access to VA electronic medical record

• Use of a continuity of care record (CCR)

Encouraging Collaboration that Builds upon Complementary Expertise of the Two Organizations

“I think we’re ready to move in the direction of partnering with the VA….VA interest hasn’t been there but I think it could make a huge difference because then we can work together on these issues. This could mean better care -- better care for the individual but also for the overall system…. If the VA was willing to talk with the goal of increasing and strengthening a connection… it may mean that we each have to do things a little differently. That’s okay. We’ve always switched things up if it means better quality care for patients. Hopefully that’s how they would approach it too. But right now their lack of effort doesn’t make us feel like they’re taking care of their veterans.”

• Formal partnerships, such as between VA and the National Health Care for the Homeless Council