Megan E. Vanneman (
Todd H. Wagner is the director of the Health Economics Resource Center and assistant director and research career scientist at the VA Palo Alto Health Care System's Center for Innovation to Implementation, in Menlo Park, California.
Health Aff (Millwood). 2020 Aug;39(8):1368-1376. doi: 10.1377/hlthaff.2019.01375.
Timely access to outpatient care was a primary driver behind the Department of Veterans Affairs' (VA's) increased purchase of community-based care under the Veterans Access, Choice, and Accountability Act of 2014, known as the Choice Act. To compare veterans' experiences in VA-delivered and community-based outpatient care after implementation of the act, we assessed veterans' scores on four dimensions of experience-access, communication, coordination, and provider rating-for outpatient specialty, primary, and mental health care received during 2016-17. Patient experiences were better for VA than for community care in all respects except access. For specialty care, access scores were better in the community; for primary and mental health care, access scores were similar in the two settings. Although all specialty care scores and the primary care coordination score improved over time, the gaps between settings did not shrink. As purchased care further expands under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, which replaced the Choice Act in 2019, monitoring of meaningful differences between settings should continue, with the results used to inform both VA purchasing decisions and patients' care choices.
及时获得门诊护理是退伍军人事务部（VA）根据 2014 年《退伍军人获得、选择和问责法案》（即选择法案）增加购买社区为基础的护理的主要驱动因素。为了比较该法案实施后退伍军人在 VA 提供的和社区为基础的门诊护理方面的体验，我们评估了退伍军人在 2016-17 年期间接受门诊专科、初级和心理健康护理的四个方面的体验：获得、沟通、协调和提供者评分。在除了获得途径以外的所有方面，VA 的患者体验都优于社区护理。在专科护理方面，社区的获得途径得分更好；在初级和心理健康护理方面，这两种护理在两个环境中的获得途径得分相似。尽管所有专科护理评分和初级保健协调评分都随时间提高，但各环境之间的差距并没有缩小。随着 2018 年《退伍军人事务部维护内部系统和加强综合外部网络法案》（VA 取代了 2019 年的选择法案）下购买护理的进一步扩大，应继续监测各环境之间的有意义差异，将结果用于告知 VA 的采购决策和患者的护理选择。
