Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, USA.
Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
J Gen Intern Med. 2019 Oct;34(10):2141-2149. doi: 10.1007/s11606-019-05224-y. Epub 2019 Aug 6.
To address concerns about Veterans' access to care at US Department of Veterans Affairs (VA) healthcare facilities, the Veterans Access, Choice, and Accountability Act was enacted to facilitate Veterans' access to care in non-VA settings, resulting in the "Veterans Choice Program" (VCP).
To assess the characteristics of Veterans who used or planned to use the VCP, reasons for using or planning to use the VCP, and experiences with the VCP.
Mixed-methods.
After sampling Veterans in the Midwest census region receiving care at VA healthcare facilities, we included 4521 Veterans in the analyses. Of these, 60 Veterans participated in semi-structured qualitative interviews.
Quantitative data were derived from VA's administrative and clinical data and a survey of Veterans including Veteran characteristics and self-reported use of VCP. Associations between Veterans' characteristics and use or planned use of the VCP were assessed using logistic regression analysis. Interview data were analyzed using thematic analysis.
Veterans with a higher odds of reporting use or intended use of the VCP were women, lived further distances from VA facilities, or had worse health status than other Veterans (P ≤ 0.01). Key themes included positive experiences with the VCP (timeliness of care, location of care, access to services, scheduling improvements, and coverage of services), and negative experiences with the VCP (complicated scheduling processes, inconveniently located appointments, delays securing appointments, billing confusion, and communication breakdowns).
Our findings suggest that Veterans value access to care close to their home and care that addresses the needs of women and Veterans with poor health status. The Mission Act was passed in June 2018 to restructure the VCP and consolidate community care into a single program, continuing VA's commitment to support access to community care into the future.
为解决退伍军人在美国退伍军人事务部 (VA) 医疗设施获得医疗服务的问题，颁布了《退伍军人获取医疗照顾法》，以促进退伍军人在非 VA 环境中获得医疗服务，从而产生了“退伍军人选择计划” (VCP)。
评估使用或计划使用 VCP 的退伍军人的特征、使用或计划使用 VCP 的原因，以及使用 VCP 的体验。
混合方法。
在对中西部地区接受 VA 医疗设施护理的退伍军人进行抽样后，我们对 4521 名退伍军人进行了分析。其中，有 60 名退伍军人参加了半结构化定性访谈。
VA 的行政和临床数据以及退伍军人调查得出了定量数据，其中包括退伍军人特征和自我报告的 VCP 使用情况。使用逻辑回归分析评估退伍军人特征与使用或计划使用 VCP 之间的关联。使用主题分析对访谈数据进行分析。
报告使用或打算使用 VCP 的退伍军人中，女性、距离 VA 设施较远或健康状况较差的退伍军人更有可能使用 VCP（P ≤ 0.01）。关键主题包括对 VCP 的积极体验（护理的及时性、护理地点、服务的可及性、预约改进和服务覆盖）和对 VCP 的消极体验（预约安排过程复杂、预约地点不便、预约安排延迟、计费混乱和沟通中断）。
我们的研究结果表明，退伍军人重视离家近的医疗服务和能满足女性和健康状况较差的退伍军人需求的医疗服务。《使命法案》于 2018 年 6 月通过，以改组 VCP，并将社区护理整合到一个单一的计划中，这延续了 VA 对未来支持社区护理的承诺。
