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实施《退伍军人事务部维护内部系统和加强外部综合网络法案》后社区急诊利用率。

Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act.

机构信息

Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park.

Department of Emergency Medicine, University of California, San Francisco.

出版信息

Med Care. 2021 Jun 1;59(Suppl 3):S314-S321. doi: 10.1097/MLR.0000000000001549.

Abstract

BACKGROUND

Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities.

OBJECTIVES

The aim was to describe trends in UC use, identify predictors of UC benefit use, and understand the factors associated with community UC use versus VA emergency department (ED) or urgent care center (UCC) use.

STUDY DESIGN

Using VA administrative data, this was a retrospective cross-sectional study of Veterans that were enrolled in VA in FY19. Veterans were classified into 3 groups: UC benefit users, benefit non-users, and VA ED/UCC users.

METHODS

We used summary statistics to compare population characteristics across user groups. To determine whether predisposing, enabling, and need factors predicted UC benefit use and setting choice (community UCC vs. VA ED/UCC), 2 logistic regression models were fitted to assess odds of UC use.

RESULTS

From June 6, 2019 through February 29, 2020, 138,305 Veterans made 175,821 community UC visits. The majority of visits were made by White males who were not subject to co-pays. The average cost to VA for UC visits was $132 (SD=$135). Upper respiratory infections were the most common reason for UC use. Being younger, female, and living farther from a VA ED/UCC was associated with greater UC benefit use compared with both benefit non-users and VA ED/UCC users.

CONCLUSIONS

The new benefit expands Veteran access to UC services for low-acuity conditions.

摘要

背景

自 2019 年 6 月 6 日起,退伍军人事务部(VA)开始提供新的紧急护理(UC)福利,使符合条件的退伍军人能够在当地社区获得更多的护理选择和机会,以治疗轻伤和疾病。

目的

本研究旨在描述 UC 使用趋势,确定 UC 福利使用的预测因素,并了解与社区 UC 使用与 VA 急诊部(ED)或紧急护理中心(UCC)使用相关的因素。

研究设计

本研究使用 VA 管理数据,对 FY19 期间在 VA 注册的退伍军人进行了回顾性横断面研究。退伍军人分为 3 组:UC 福利使用者、福利非使用者和 VA ED/UCC 使用者。

方法

我们使用汇总统计数据比较了用户组之间的人口特征。为了确定倾向因素、促成因素和需求因素是否预测 UC 福利使用和选择(社区 UCC 与 VA ED/UCC),我们拟合了 2 个逻辑回归模型来评估 UC 使用的可能性。

结果

从 2019 年 6 月 6 日至 2020 年 2 月 29 日,有 138305 名退伍军人进行了 175821 次社区 UC 就诊。大多数就诊者是白人男性,他们无需支付共付额。VA 为 UC 就诊支付的平均费用为 132 美元(SD=135 美元)。上呼吸道感染是 UC 使用最常见的原因。与福利非使用者和 VA ED/UCC 使用者相比,年龄较小、女性和距离 VA ED/UCC 较远与 UC 福利使用增加有关。

结论

新福利扩大了退伍军人对低危疾病 UC 服务的获得。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4480/8132890/ea39a03b88b6/mlr-59-s314-g001.jpg

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