Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, Texas, USA.
Health Serv Res. 2024 Feb;59(1):e14241. doi: 10.1111/1475-6773.14241. Epub 2023 Sep 26.
To estimate whether those enrolled in the Veterans Health Administration (VHA) were less likely to use VHA-delivered colorectal cancer screening colonoscopies after the MISSION Act.
Secondary data were collected on VHA-enrolled Veterans from FY2017-FY2021.
This retrospective cross-sectional study measured the volume and share of screening colonoscopies that were VHA-delivered over time and by drive time eligibility-defined as living more than 60 min away from the nearest VHA specialty-care clinic. We used a multivariable logistic regression to adjust for patient and facility factors.
Data were extracted for VHA enrollees (n = 773,766) who underwent a screening colonoscopy either performed or purchased by the VHA from FY2017-FY2021.
In the 9 months after the implementation of the MISSION Act, and before the onset of the Covid-19 pandemic, the average monthly VHA-share of screening colonoscopies decreased by 3 percentage points (pp; 95% confidence interval [CI] = [-4 to -2 pp]) for the non-drive time eligible group and it decreased by 16 pp (95% CI = [-22 to -9 pp]) for the drive time eligible group. The total number of screening colonoscopies did not significantly change in either group during this time period. After adjusting for patient characteristics, a linear time trend, and parent facility fixed effects, implementation of the MISSION Act was associated with a reduction in the probability of a VHA-delivered screening colonoscopy (average marginal effect [AME]: -2.5 pp; 95% CI = [-5.1 to 0.0 pp]) for the non-drive time eligible group. The drive time eligible group (AME: -9.4 pp; 95% CI = [-13.2 to -5.5 pp]) experienced a larger change.
The VHA-share of screening colonoscopies among VHA enrollees fell in the 9 months immediately after the passage of the MISSION Act. This decline was larger for VHA enrollees who were targeted for eligibility due to a longer drive time. These results suggest that the MISSION Act led to more VHA-purchased care among targeted VHA enrollees, though it is unclear whether total utilization increased.
评估在《使命法案》（MISSION Act）颁布后，参加退伍军人健康管理局（VHA）的患者接受 VHA 提供的结直肠癌筛查结肠镜检查的可能性是否降低。
从 2017 财政年度到 2021 财政年度，收集了关于 VHA 登记退伍军人的二级数据。
这项回顾性的横断面研究测量了随着时间的推移和按行车时间资格（定义为距离最近的 VHA 专科诊所超过 60 分钟），VHA 提供的筛查结肠镜检查的数量和比例。我们使用多变量逻辑回归来调整患者和医疗机构因素。
从 2017 财政年度至 2021 财政年度，从接受 VHA 进行或购买的筛查结肠镜检查的 VHA 登记患者（n=773766）中提取数据。
在《使命法案》实施后的 9 个月内，也就是新冠疫情爆发之前，非行车时间合格组的 VHA 筛查结肠镜检查比例每月平均下降 3 个百分点（95%置信区间[CI]：[-4 至-2 个百分点]），而行车时间合格组则下降了 16 个百分点（95%CI：[-22 至-9 个百分点]）。在此期间，两组的筛查结肠镜检查总数均未显著变化。在调整了患者特征、线性时间趋势和母设施固定效应后，《使命法案》的实施与 VHA 提供的筛查结肠镜检查的概率降低相关（平均边际效应[AME]：-2.5 个百分点；95%CI：[-5.1 至 0.0 个百分点]），对于非行车时间合格组。行车时间合格组（AME：-9.4 个百分点；95%CI：[-13.2 至-5.5 个百分点]）的变化更大。
在《使命法案》通过后的 9 个月内，VHA 登记退伍军人中筛查结肠镜检查的 VHA 份额下降。对于因行车时间较长而有资格获得 VHA 服务的退伍军人，这一下降幅度更大。这些结果表明，《使命法案》导致了更多针对目标 VHA 登记退伍军人的 VHA 购买护理，尽管尚不清楚总利用率是否增加。
