How Did Veterans' Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?
How Did Veterans' Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?
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DOI：
10.1097/mlr.0000000000001764
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发表时间：
2022-10-01
期刊：
影响因子：
3
通讯作者：
Wong, Edwin S.
中科院分区：
文献类型：
--
作者：
Sterling, Ryan A.;Liu, Chuan-Fen;Wong, Edwin S.
背景资料：退伍军人社区护理计划（VCCP）旨在通过补偿非VA社区提供者的护理来解决退伍军人健康管理局（VA）的准入限制。现有的研究很少探讨退伍军人对VA与VCCP供应商的选择如何演变为2014年VCCP的重大扩张，作为退伍军人准入，选择和责任法案的一部分。目的：我们研究了依赖VA的初级保健（PC），心理健康（MH）和专科护理（SC）之间的VCCP合格的退伍军人的变化。研究设计：我们将VA行政数据与VCCP索赔联系起来，回顾性检查2016 - 2018日历年的利用率。受试者：178万退伍军人在2013年之前加入VA，2016年由于VA能力有限或旅行困难而符合VCCP资格。措施：我们测量了PC、MH和SC在VA中发生的年度总门诊（VA + VCCP）访视的比例。在确定的2610万次门诊就诊中，45.6%为MH，29.9%为PC，24.4%为SC。在3年中，83.2%的退伍军人使用任何VA服务，23.8%使用任何VCCP服务，20.0%为VA-VCCP双重使用者。从2016年到2018年，PC（94.5%-92.2%）和MH（97.8%-96.9%）的依赖程度略有下降，但具有统计学意义，SC（88.5%-79.8%）的下降幅度更大。结论：在2014年VCCP扩张后的最初几年，可以选择VA或VCCP提供者的退伍军人继续使用VA进行大部分门诊治疗。
Background: The Veterans Community Care Program (VCCP) aims to address access constraints in the Veterans Health Administration (VA) by reimbursing care from non-VA community providers. Little existing research explores how veterans' choice of VA versus VCCP providers has evolved as a significant VCCP expansion in 2014 as part of the Veterans Access, Choice, and Accountability Act. Objectives: We examined changes in reliance on VA for primary care (PC), mental health (MH), and specialty care (SC) among VCCP-eligible veterans. Research Design: We linked VA administrative data with VCCP claims to retrospectively examine utilization during calendar years 2016-2018. Subjects: 1.78 million veterans enrolled in VA before 2013 and VCCP-eligible in 2016 due to limited VA capacity or travel hardship. Measures: We measured reliance as the proportion of total annual outpatient (VA+VCCP) visits occurring in VA for PC, MH, and SC. Results: Of the 26.1 million total outpatient visits identified, 45.6% were for MH, 29.9% for PC, and 24.4% for SC. Over the 3 years, 83.2% of veterans used any VA services, 23.8% used any VCCP services, and 20.0% were dual VA-VCCP users. Modest but statistically significant declines in reliance were observed from 2016-2018 for PC (94.5%-92.2%), and MH (97.8%-96.9%), and a more significant decline was observed for SC (88.5%-79.8%). Conclusions: Veterans who have the option of selecting between VA or VCCP providers continued using VA for most of their outpatient care in the initial years after the 2014 VCCP expansion.