Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Medicine (Baltimore). 2023 Aug 18;102(33):e34814. doi: 10.1097/MD.0000000000034814.
Following recent policy changes, younger Veterans have particularly increased options for where to receive their health care. Although existing research provides some understanding of non-modifiable individual (e.g., age) and external community (e.g., non-VA provider supply) factors that influence VA enrollment, this study focused on modifiable facility access and quality factors that could influence Veterans' decisions to enroll in VA. In this cohort study, we examined enrollment in and use of VA services in the year following military separation as the binary outcome using mixed-effects logistic regressions, stratified by Active and Reserve Components. This study included 260,777 Active and 101,572 Reserve Component post-9/11 Veterans separated from the military in fiscal years 2016 to 2017. Independent variables included 4 access measures for timeliness of VA care and 3 VA quality measures, which are included in VA Medical Centers' performance plans. Eligible Veterans were more likely to enroll in VA when the closest VA had higher quality scores. After accounting for timeliness of VA care and non-modifiable characteristics, rating of primary care (PC) providers was associated with higher VA enrollment for Active Component (odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.007-1.020). Higher mental health (MH) continuity (OR = 1.039, 95% CI: 1.000-1.078) and rating of PC providers (OR = 1.009, 95% CI: 1.000-1.017) were associated with higher VA enrollment for Reserve Component. Improving facility-specific quality of care may be a way to increase VA enrollment. In a changing policy environment, study results will help VA leadership target changes they can make to manage enrollment of Veterans in VA and deliver needed foundational services.
继最近的政策变化后，年轻退伍军人在选择医疗服务机构方面有了更多的选择。虽然现有研究对影响退伍军人事务部（VA）入组的不可改变的个体（例如，年龄）和外部社区（例如，非 VA 供应商供应）因素有一定的了解，但本研究侧重于可改变的设施准入和质量因素，这些因素可能会影响退伍军人入组 VA 的决策。在这项队列研究中，我们使用混合效应逻辑回归，按现役和后备役成分进行分层，将军事分离后一年内 VA 服务的入组和使用情况作为二元结果进行了检查。这项研究包括 260777 名现役和 101572 名 9/11 后后备役退伍军人，他们在 2016 财年至 2017 财年期间从军队中分离出来。自变量包括 VA 护理及时性的 4 项准入措施和 3 项 VA 质量措施，这些措施都包含在 VA 医疗中心的绩效计划中。当最近的 VA 医疗中心具有更高的质量评分时，退伍军人更有可能选择 VA 入组。在考虑 VA 护理及时性和不可改变的特征后，初级保健（PC）提供者的评分与现役人员更高的 VA 入组率相关（优势比 [OR] = 1.014，95%置信区间 [CI]：1.007-1.020）。更高的心理健康（MH）连续性（OR = 1.039，95% CI：1.000-1.078）和 PC 提供者评分（OR = 1.009，95% CI：1.000-1.017）与后备役更高的 VA 入组率相关。提高特定设施的医疗质量可能是增加 VA 入组率的一种方法。在不断变化的政策环境下，研究结果将帮助 VA 领导层确定可以做出哪些改变来管理退伍军人在 VA 的入组情况并提供必要的基础服务。
