Abstract
Background:
Pulmonary hypertension (PH) care requires extensive resources and support, including expert multidisciplinary teams, advanced diagnostic modalities, and complex pharmacologic therapies. While this infrastructure is standardized within accredited PH centers, less is known about resource availability outside of PH centers, where most patients with PH receive care.
Objective:
To explore PH-specific resource availability across the Veterans Health Administration (VA), which cares for over 250,000 patients with PH.
Research Design, Subjects, and Measures:
Between November 2024 and January 2025, we surveyed pulmonary and cardiology providers within 66 highly resourced VA medical centers, exploring PH-specific structures, resources, and programs through structured and open-ended questions. We summarized structured responses as counts (percentages) by site and analyzed free-text responses using conventional content analysis. We overlayed maps of VA sites with PH experts and non-VA PH centers and associated 60-minute drive times.
Results:
Providers at 61 sites responded (site-level response 92.4%). 57.4% of sites had a PH expert physician; few sites had other key personnel or PH-specific programs. Free-text responses highlighted (1) an overall lack of VA PH resources, (2) the value of PH expert physicians, (3) the need for PH support staff, and (4) challenges to providing PH-specific therapies. Geographic analyses revealed insufficient access to PH expertise in many U.S. regions.
Conclusions:
Within the largest U.S. integrated health care system, there is a paucity of resources vital for PH care. These findings highlight the need for strategies to build PH-specific resource infrastructure within VA and to better understand how these gaps affect PH care quality.