Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Roberta Lavin, PhD


Calvert, Wilma

Yakimo, Rick

Hartranft, Elise


Background: Many Veterans Health Administration (VHA) facilities have cardiac services, but not all VHA centers offer heart failure care. Viable alternative models exist to traditional outpatient treatment by physicians, such as Tele-medicine consultations, the use of nurse practitioner run clinics, and the use of models such as Specialty Care Access Network-Extension for Community (SCAN-ECHO) and site specific contracted physician services models. These have the potential to improve Veteran access to care. Objective: The purpose of this change project was to conduct a needs assessment survey, in joint effort with the Hershey Medical Center Heart and Vascular Institute, to identify barriers and improve service and communication for veterans receiving heart failure care via a contracted provider services model of the Penn State Hershey Medical Center. Methods: A two round modified Delphi process was implemented to identify the major issues that present barriers to specialty care for veterans and their providers. The questionnaire was sent to physicians and nurse practitioners. Surveys included analogous questions for all parties in order to compare and contrast responses and see how they differed. Results: The majority of respondents agreed that timeliness of procedures is questionable secondary to the VHA dictating where those procedures are to be done, i.e. cardiac catheterizations, or electrophysiology studies in Philadelphia. The VHA clinic has less support staff and longer wait times, often resulting in decreased Veteran access to care. The inability to access electronic medical records outside of the VHA institution (remote access) can often lead to further delays in care to Veterans. Reliable remote access to the Veterans Administration electronic medical record would improve the treatment experience for Veterans. The respondents also agreed that a nurse practitioner on site at the VHA to coordinate care and provide follow-up and liaison service would be beneficial. Conclusions: There is a communication gap that exists for providers when seeing patients at the VHA. The addition of a Nurse Practitioner on-site could help to close communication gaps, provide follow up and maintain a consistent presence for the Veterans receiving heart failure care via a contracted provider model. Quality Improvement, Delphi Technique, Veterans, Heart failure, Health Services Accessibility

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Nursing Commons