Did Access to Care Improve Since Passage of the Veterans Choice Act?: Differences Between Rural and Urban Veterans.
Did Access to Care Improve Since Passage of the Veterans Choice Act?: Differences Between Rural and Urban Veterans.
复制标题
自退伍军人选择法案通过以来，获得医疗服务的机会有改善吗？：农村和城市退伍军人之间的差异。
DOI：
10.1097/mlr.0000000000001490
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发表时间：
2021-06-01
期刊：
影响因子：
3
通讯作者：
Rosen AK
中科院分区：
文献类型：
--
作者：
Gurewich D;Shwartz M;Beilstein-Wedel E;Davila H;Rosen AK
补充数字内容可在文本中找到。2014年退伍军人选择计划旨在通过扩大社区护理（CC）的可用性来改善退伍军人的护理机会。增加获得CC的机会可能特别有利于农村退伍军人，他们在退伍军人健康管理局（VHA）获得医疗保健时经常面临障碍。然而，退伍军人选择计划是否改善了这一弱势群体及时获得护理的机会，这一点尚未得到充分研究。研究农村和城市退伍军人对5种门诊专科护理服务的等待时间，这些服务代表了农村退伍军人对CC服务的最高要求。回顾性研究使用VHA公司数据仓库中2015财年（2014年10月1日至2015年9月30日）和2018财年（2017年10月1日至2018年9月30日）的VHA和CC门诊咨询数据。在VHA和/或CC接受物理治疗、心脏病学、验光、骨科和/或牙科服务的新患者咨询的所有退伍军人。等待时间、护理环境（VHA/CC）、农村/城市状况、社会人口统计学和合并症。我们的样本包括1,112,876名退伍军人。在2015财年至2018财年期间，农村和城市退伍军人的所有服务的平均等待时间都有所下降; VHA的下降幅度最大（例如，VHA与CC中农村退伍军人的平均验光等待时间分别下降8.3与6.4天，P<0.0001）。到2018财年，对于农村和城市退伍军人，CC意味着大多数服务的等待时间都长于VHA等待时间。在FY 15和FY 18之间，所有退伍军人获得及时护理的机会得到了改善，特别是在VHA。随着CC的扩大继续根据使命法案，需要更多的研究来评估整个VHA和CC的护理质量，以及等待时间发挥的作用。
Supplemental Digital Content is available in the text. The 2014 Veterans Choice Program aimed to improve care access for Veterans through expanded availability of community care (CC). Increased access to CC could particularly benefit rural Veterans, who often face obstacles in obtaining medical care at the Veterans Health Administration (VHA). However, whether Veterans Choice Program improved timely access to care for this vulnerable population is understudied. To examine wait times among rural and urban Veterans for 5 outpatient specialty care services representing the top requests for CC services among rural Veterans. Retrospective study using VHA and CC outpatient consult data from VHA’s Corporate Data Warehouse in Fiscal Year (FY) 2015 (October 1, 2014 to September 30, 2015) and FY2018 (October 1, 2017 to September 30, 2018). All Veterans who received a new patient consult for physical therapy, cardiology, optometry, orthopedics, and/or dental services in VHA and/or CC. Wait time, care setting (VHA/CC), rural/urban status, sociodemographics, and comorbidities. Our sample included 1,112,876 Veterans. Between FY2015 and FY2018, mean wait times decreased for all services for both rural and urban Veterans; declines were greatest in VHA (eg, mean optometry wait times for rural Veterans in VHA vs. CC declined 8.3 vs. 6.4 d, respectively, P<0.0001). By FY2018, for both rural and urban Veterans, CC mean wait times for most services were longer than VHA wait times. Timely care access for all Veterans improved between FY15 and FY18, particularly in VHA. As expansion of CC continues under the MISSION Act, more research is needed to evaluate quality of care across VHA and CC and what role, if any, wait times play.