VA Boston Healthcare System.
Boston University School of Medicine.
Med Care. 2021 Jun 1;59(Suppl 3):S286-S291. doi: 10.1097/MLR.0000000000001552.
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.
2014 年《退伍军人医疗保健选择和问责法案》旨在通过扩大退伍军人获得社区医疗保健（CC）的选择范围，从而改善退伍军人及时获得医疗保健的机会，这些 CC 由退伍军人健康管理局（VA）支付费用。尽管 CC 可能特别有益于农村退伍军人，但我们对农村退伍军人接受 CC 的经历知之甚少。
本研究旨在比较农村退伍军人接受 CC 和 VA 门诊医疗保健服务的经历与城市退伍军人的经历，并考察随时间的变化。
使用来自患者医疗保健体验调查（SHEP）和 VA 公司数据仓库的数据进行回顾性、横断面研究。研究对象：所有在财政年度（FY）16 或 FY19 回答 SHEP 调查的退伍军人。
结局为 4 项医疗保健体验指标（可及性、沟通、协调和提供者评分）。自变量包括护理环境（CC/VA）、农村/城市状况以及人口统计学和临床特征。
与城市退伍军人相比，农村退伍军人对 CC 的评价相同（针对专科护理）或更好（针对初级保健）。农村退伍军人在 CC 方面的护理体验比 VA 差，除了专科护理的可及性。农村退伍军人在 CC 和 VA 中的护理体验在 FY16 和 FY19 之间均有所改善，CC 的改善更大。
与城市退伍军人相比，农村退伍军人报告的 CC 体验可与之相媲美甚至更好，但农村退伍军人的 CC 体验在初级保健方面仍落后于 VA。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使用 CC 的体验至少与 VA 护理的体验相媲美。
