Abstract Rationale Caring for patients with pulmonary hypertension (PH) requires intensive care coordination within multidisciplinary PH teams, between inpatient and outpatient settings, and often across healthcare systems. While the importance of care coordination in PH is well-established, less is known about specific factors influencing PH care coordination, information that could inform future efforts to improve coordination of PH care. We therefore sought to explore provider- and facility-level characteristics associated with PH care coordination within the Veterans Health Administration (VA), which cares for 250,000 patients with PH across diverse settings. Methods Between November 2024 and January 2025, we conducted an online survey of pulmonologists, cardiologists, and PH clinical staff within 66 of the most highly resourced VA medical centers (VAMCs). Our primary outcome was the perceived level of PH care coordination within VA (measured on a scale of 1-10). We additionally captured perceived care coordination across VA and non-VA settings using the same scale. We compared care coordination scores within VA versus across VA and non-VA settings using paired t-tests. We assessed the association between provider- and facility-level characteristics and PH care coordination scores within VA using hierarchical proportional odds models with VAMC as a random effect. Finally, we captured provider perspectives on VA PH care through open-ended questions and analyzed free text responses using conventional content analysis with inductive coding. Results 228 providers (individual response rate=16.2%) from 61 VAMCs (facility-level response rate=92.4%) responded to the survey. The mean (SD) care coordination score was 6.42 (2.32) within VA versus 5.37 (2.44) across VA and non-VA settings (p-value 0.01). Providers at facilities with PH clinics (OR 2.60, 95% CI 1.44-4.70) or PH-specific protocols (OR 2.83, 95% CI 1.32-6.05) were more likely to perceive higher PH care coordination (Table). Free-text responses mirrored structured responses, with providers noting the added challenges in coordinating PH care across VA and non-VA settings (“Community care is an unmitigated disaster, from the communication to the quality of non-VA care”) and the benefit of PH clinics when present (“Our dedicated PH clinic⋯is excellent and prevents community referrals”). Conclusions Within the largest integrated healthcare system in the U.S., perceived coordination of PH care is higher within VA versus across VA and non-VA settings, highlighting the challenges in cross-health system PH care coordination. Facility-level factors associated with improved PH care coordination such as PH clinics and specific PH protocols offer actionable solutions to improve care coordination for this vulnerable patient population. This abstract is funded by: VA HSR CDA 22-140
Gillmeyer et al. (Fri,) studied this question.