US Department of Veterans Affairs (VA), VA Portland Healthcare System, Center to Improve Veteran Involvement in Care (CIVIC), Portland.
College of Public Health and Human Sciences, Oregon State University, Corvallis.
Med Care. 2021 Jun 1;59(Suppl 3):S292-S300. doi: 10.1097/MLR.0000000000001554.
The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers.
The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider.
This was a retrospective, observational over fiscal years (FY) 2015-2018.
Veterans receiving primary care services paid for by the VA.
Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year.
There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care.
As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans' use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans' health care needs are met.
退伍军人选择计划（VCP）旨在改善获得医疗保健的机会，扩大了退伍军人通过社区提供者获得初级保健的选择。
本研究的目的是描述和比较退伍军人在退伍军人事务部（VA）设施和退伍军人事务部社区保健网络（VA-CCN）提供者处使用退伍军人事务部初级保健服务的情况。
这是一项回顾性、观察性研究，跨越财政年度（FY）2015-2018。
接受退伍军人事务部支付的初级保健服务的退伍军人。
退伍军人的人口统计学、社会经济和临床因素以及每年退伍军人事务部初级保健服务的使用情况。
有 630 万退伍军人接受了超过 5400 万次退伍军人事务部初级保健服务，其中主要（98.5%的就诊）在退伍军人事务部设施中。VA-CCN 就诊的比例绝对值从 2015 年的 0.7%增加到 2018 年的 2.6%。在有任何 VA-CCN 初级保健的退伍军人中，VA-CCN 就诊的比例从 22.6%增加到 55.3%。逻辑回归表明，女性、居住在农村地区、驾驶距离>40 英里、有医疗保险或有精神疾病/抑郁状况的退伍军人更有可能接受 VA-CCN 初级保健。年龄较大、被认定为黑人、需要支付退伍军人事务部共付额或 Nosos 评分较高的退伍军人不太可能接受 VA-CCN 初级保健。
随着退伍军人事务部从 VCP 过渡到 MISSION 以及退伍军人事务部设施在新合同下获得经验，关注影响退伍军人在不同环境中使用初级保健服务的因素对于监测获取障碍并确保退伍军人的医疗保健需求得到满足非常重要。
