QUERI – Quality Enhancement Research Initiative

Go to the HSRD website

A Mixed-Method, Multi-Site Evaluation of the Implementation of the Veterans Choice Act

Denver, CO, Cleveland, OH, and Seattle, WA


This multi-site QUERI evaluation project (Cleveland, Denver and Seattle) is well positioned to conduct timely evaluations of the Veteran's Choice Act (VCA) implementation, using rigorous methodology to address questions of whether the program is working and what makes it work. Their evaluation team has extensive experience evaluating national programs (e.g., Specialty Care Transformational Initiatives) in close collaboration with operational partners. These findings have informed operational partners, including the Chief Consultant for VA Specialty Care Services and the Under Secretary for Health, and led to program refinement, implementation, dissemination, and policy change for the field. They also have an established evaluation infrastructure and are well-positioned to evaluate the VCA to produce timely and actionable deliverables.


This project includes an in-depth evaluation comprised of detailed qualitative analyses at three VA healthcare systems (Cleveland, Denver and Seattle) and quantitative analyses of three VISNs (10, 19, 20), which involve two third-party administrator (TPA) regions. [TPAs are organizations that process insurance claims or specific aspects of employee benefit plans for a separate organization.] The evaluation will be guided by RE-AIM, which is a framework for assessing the impact of health programs. Two evaluation sites (Denver and Seattle) serve many Veterans who live in rural settings, and thus have a high percentage of Veterans eligible for the Choice Program. Cleveland provides an important contrast as Veterans are primarily eligible based on the 30-day waitlist. This project will examine:

  • Work stream
  • Patient outcomes,
  • Access and wait times, and
  • Provider and system factors influencing implementation.


This QUERI evaluation project will assess and identify:

  • Patient characteristics of Choice Program users;
  • Changes in geospatial access to care associated with Choice Program use based on specialty care available to the Veterans;
  • Location and specialty of providers seeing Veterans through the Choice Program, as well as optimal new potential clinic locations for TPA to improve patient access to care;
  • Changes in wait times for each specialty within a medical center, and the association between Choice Program use and facility wait times; and
  • Impact of Choice Program on Veterans and providers.

Based on these findings, investigators will develop recommendations for how to improve processes of Choice Program implementation.

Operations Partners: VA Specialty Care Services and the Under Secretary for Health.

Principal Investigator: Michael P. Ho, MD, PhD; contact at Michael.Ho@va.gov .