Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS), Salt Lake City Health Care System, Salt Lake City, UT, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
J Gen Intern Med. 2019 Sep;34(9):1925-1933. doi: 10.1007/s11606-019-05116-1.
The 2014 Veterans Access, Choice and Accountability Act (i.e., "Choice") allows eligible Veterans to receive covered health care outside the Veterans Affairs (VA) Healthcare System. The initial implementation of Choice was challenging, and use was limited in the first year.
To assess satisfaction with Choice, and identify reasons for satisfaction and dissatisfaction during its early implementation.
Semi-structured telephone interviews from July to September 2015 with Choice-eligible Veterans from 25 VA facilities across the USA.
Satisfaction was assessed with 5-point Likert scales and open-ended questions. We compared ratings of satisfaction with Choice and VA health care, and identified reasons for satisfaction/dissatisfaction with Choice in a thematic analysis of open-ended qualitative data.
Of 195 participants, 35 had not attempted to use Choice; 43 attempted but had not received Choice care (i.e., attempted only); and 117 attempted and received Choice care. Among those who attempted only, a smaller percentage were somewhat/very satisfied with Choice than with VA health care (17.9% and 71.8%, p < 0.001); among participants who received Choice, similar percentages were somewhat/very satisfied with Choice and VA health care (66.6% and 71.1%, p = 0.45). When asked what contributed to Choice ratings, participants who attempted but did not receive Choice care reported poor access (50%), scheduling problems (20%), and care coordination issues (10%); participants who received Choice care reported improved access (27%), good quality of care (19%), and good distance to Choice provider (16%). Regardless of receipt of Choice care, most participants expressed interest in using Choice in the future (70-82%).
Access and scheduling barriers contributed to dissatisfaction for Veterans unsuccessfully attempting to use Choice during its initial implementation, whereas improved access and good care contributed to satisfaction for those receiving Choice care. With Veterans' continued interest in using services outside VA facilities, subsequent policy changes should address Veterans' barriers to care.
2014 年退伍军人医疗保健选择和责任法案（即“选择”）允许符合条件的退伍军人在退伍军人事务部（VA）医疗保健系统之外获得医疗保险。“选择”最初的实施具有挑战性，并且在第一年的使用受到限制。
评估对“选择”的满意度，并确定在早期实施过程中满意和不满意的原因。
2015 年 7 月至 9 月，从美国 25 个 VA 设施中选择符合条件的退伍军人进行半结构化电话访谈。
使用 5 分李克特量表和开放式问题评估满意度。我们比较了对“选择”和 VA 医疗保健的满意度评分，并对开放式定性数据进行主题分析，确定了对“选择”满意/不满意的原因。
在 195 名参与者中，35 人未尝试使用“选择”；43 人尝试但未获得“选择”护理（即仅尝试）；117 人尝试并获得“选择”护理。在仅尝试的人群中，对“选择”的满意度低于对 VA 医疗保健的满意度（17.9%和 71.8%，p<0.001）；在接受“选择”的参与者中，对“选择”和 VA 医疗保健的满意度相似（66.6%和 71.1%，p=0.45）。当被问及是什么导致了对“选择”的评价时，未获得“选择”护理的参与者报告称，较差的可及性（50%）、预约问题（20%）和护理协调问题（10%）是主要原因；而获得“选择”护理的参与者则报告说，可及性提高（27%）、护理质量良好（19%）以及距离“选择”提供者较近（16%）是主要原因。无论是否接受过“选择”护理，大多数参与者都表示有兴趣在未来使用“选择”（70-82%）。
在“选择”最初实施期间，未能成功尝试使用“选择”的退伍军人，由于可及性和预约障碍而导致不满，而获得“选择”护理的退伍军人则因可及性提高和良好的护理而感到满意。鉴于退伍军人继续有兴趣在 VA 设施外使用服务，随后的政策变化应解决退伍军人护理方面的障碍。
