VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System.
Section of Plastic Surgery, Michigan Medicine.
Med Care. 2021 Jun 1;59(Suppl 3):S279-S285. doi: 10.1097/MLR.0000000000001469.
The US Department of Veterans Affairs (VA) enacted policies offering Veterans care in the community, aiming to improve access challenges. However, the impact of receipt of community care on wait times for Veterans receiving surgical care is poorly understood.
To compare wait times for surgery for Veterans with carpal tunnel syndrome who receive VA care plus community care (mixed care) and those who receive care solely within the VA (VA-only).
Retrospective cohort study.
Veterans undergoing carpal tunnel release (CTR) between January 1, 2010 and December 31, 2016.
Our primary outcome was time from primary care physician (PCP) referral to CTR.
Of the 29,242 Veterans undergoing CTR, 23,330 (79.8%) received VA-only care and 5912 (20.1%) received mixed care. Veterans receiving mixed care had significantly longer time from PCP referral to CTR (median mixed care: 378 days; median VA-only care: 176 days, P<0.001). After controlling for patient and facility covariates, mixed care was associated with a 37% increased time from PCP referral to CTR (adjusted hazard ratio, 0.63; 95% confidence interval, 0.61-0.65). Each additional service provided in the community was associated with a 23% increase in time to surgery (adjusted hazard ratio, 0.77; 95% confidence interval, 0.76-0.78).
VA-only care was associated with a shorter time to surgery compared with mixed care. Moreover, there were additional delays for each service received in the community. With likely increases in Veterans seeking community care, strategies must be used to identify and mitigate sources of delay through the spectrum of care between referral and definitive treatment.
美国退伍军人事务部（VA）制定了在社区为退伍军人提供护理的政策，旨在改善获取护理的挑战。然而，接受社区护理对接受手术护理的退伍军人的等待时间的影响知之甚少。
比较患有腕管综合征的退伍军人接受 VA 护理加社区护理（混合护理）和仅接受 VA 护理（仅 VA 护理）的手术等待时间。
回顾性队列研究。
2010 年 1 月 1 日至 2016 年 12 月 31 日期间接受腕管松解术（CTR）的退伍军人。
我们的主要结果是从初级保健医生（PCP）转诊到 CTR 的时间。
在接受 CTR 的 29242 名退伍军人中，23330 名（79.8%）接受了仅 VA 护理，5912 名（20.1%）接受了混合护理。接受混合护理的退伍军人从 PCP 转诊到 CTR 的时间明显更长（混合护理的中位数：378 天；仅 VA 护理的中位数：176 天，P<0.001）。在控制患者和设施协变量后，混合护理与 PCP 转诊至 CTR 的时间增加 37%相关（调整后的危险比，0.63；95%置信区间，0.61-0.65）。在社区提供的每一项额外服务与手术时间增加 23%相关（调整后的危险比，0.77；95%置信区间，0.76-0.78）。
与混合护理相比，仅 VA 护理与手术时间更短相关。此外，在社区接受的每项服务都会增加额外的延误。随着寻求社区护理的退伍军人数量的增加，必须使用策略来确定和减轻从转诊到明确治疗的整个护理过程中延迟的来源。
