Rural Veterans' Experiences With Outpatient Care in the Veterans Health Administration Versus Community Care.
Rural Veterans' Experiences With Outpatient Care in the Veterans Health Administration Versus Community Care.
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DOI：
10.1097/mlr.0000000000001552
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发表时间：
2021-06-01
期刊：
影响因子：
3
通讯作者：
Gurewich D
中科院分区：
文献类型：
--
作者：
Davila H;Rosen AK;Beilstein-Wedel E;Shwartz M;Chatelain L Jr;Gurewich D
文本中提供了补充数字内容。 2014 年退伍军人准入、选择和责任法案旨在通过扩大退伍军人接受由退伍军人健康管理局 (VA) 付费的社区护理 (CC) 的选择，改善退伍军人获得及时医疗保健的机会。尽管 CC 特别有利于农村退伍军人，但我们对农村退伍军人在 CC 方面的经历知之甚少。本研究的目的是将农村退伍军人与城市退伍军人接受 CC 和 VA 门诊医疗服务的经历进行比较，并研究随时间的变化。使用来自患者医疗保健体验调查 (SHEP) 和 VA 企业数据仓库的数据进行回顾性横断面研究。对象：在 16 财年 (FY) 或 2019 财年对 SHEP 调查做出回应的所有退伍军人。结果是护理体验的 4 项衡量标准（访问、沟通、协调和提供者评级）。自变量包括护理环境 (CC/VA)、农村/城市状况以及人口和临床特征。与城市退伍军人相比，农村退伍军人对 CC 的评价相同（针对专业护理）或更好（针对初级护理）。农村退伍军人报告说，除了特殊护理服务之外，CC 的体验比 VA 的体验更差。 2016 财年至 2019 财年，农村退伍军人在 CC 和 VA 方面的护理体验均有所改善，其中 CC 方面的改善更大。农村退伍军人报告的 CC 体验与城市退伍军人相当或更好，但农村退伍军人的 CC 体验仍然落后于他们在 VA 初级保健方面的体验。随着越来越多的退伍军人使用 CC，VA 应确保农村和城市退伍军人的 CC 体验至少与 VA 护理体验相当。
Supplemental Digital Content is available in the text. The 2014 Veterans Access, Choice and Accountability Act was intended to improve Veterans’ access to timely health care by expanding their options to receive community care (CC) paid for by the Veterans Health Administration (VA). Although CC could particularly benefit rural Veterans, we know little about rural Veterans’ experiences with CC. The objective of this study was to compare rural Veterans’ experiences with CC and VA outpatient health care services to those of urban Veterans and examine changes over time. Retrospective, cross-sectional study using data from the Survey of Healthcare Experiences of Patients (SHEP) and VA Corporate Data Warehouse. Subjects: All Veterans who responded to the SHEP survey in Fiscal Year (FY) 16 or FY19. Outcomes were 4 measures of care experience (Access, Communication, Coordination, and Provider Rating). Independent variables included care setting (CC/VA), rural/urban status, and demographic and clinical characteristics. Compared with urban Veterans, rural Veterans rated CC the same (for specialty care) or better (for primary care). Rural Veterans reported worse experiences in CC versus VA, except for specialty care Access. Rural Veterans’ care experiences improved between FY16 and FY19 in both CC and VA, with greater improvements in CC. Rural Veterans’ reported comparable or better experiences in CC compared with urban Veterans, but rural Veterans’ CC experiences still lagged behind their experiences in VA for primary care. As growing numbers of Veterans use CC, VA should ensure that rural and urban Veterans’ experiences with CC are at least comparable to their experiences with VA care.