Yoon Jean, Chow Adam, Jiang Hao, Wong Emily, Chang Evelyn T
Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, CA, USA.
Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
J Gen Intern Med. 2025 Feb;40(3):647-653. doi: 10.1007/s11606-024-08968-4. Epub 2024 Aug 5.
The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to independent community providers outside the Veterans Health Administration (VA). Little is known how quality, costs, and outcomes of primary care received in the community compare to that of the VA.
To compare quality, costs, and outcomes of community and VA-provided primary care for patients with diabetes over a 12-month episode.
A cross-sectional study using VA administrative data and community care claims. Adjusted analyses were conducted using inverse probability weighted regression adjustment to balance patient characteristics.
Veterans with diabetes receiving primary care in the VA or community.
Quality measures included receipt of hemoglobin A1C tests, eye exams, microalbumin urine tests, and flu shots. Outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC). Costs were measured for VA and community outpatient care, inpatient care, and prescription drugs.
There were 652,648 VA patients and 3650 community care patients. VA patients were less likely to be White, had shorter mean drive time to VA primary care, and were less likely to be rural than community care patients. In adjusted analyses, community care patients had significantly lower probability of receiving a hemoglobin A1C test, eye exam, microalbumin urine test, and flu shot compared to the VA group. There was no difference in probability of an ACSC hospitalization. Community care patients had higher mean total costs ($1741 [95% CI, $431, $3052]), driven by higher inpatient and prescription drug costs but lower emergency care costs than VA patients.
Patients receiving community primary care had worse diabetes quality and higher costs than patients receiving VA primary care. There was no difference in health outcomes. Care provided by an integrated delivery system may have advantages in quality and value.
《维持内部系统与加强外部综合网络（MISSION）法案》扩大了退伍军人健康管理局（VA）以外独立社区医疗服务提供者的服务范围。目前对于社区提供的初级保健服务的质量、成本和结果与退伍军人健康管理局的服务相比情况知之甚少。
比较社区和退伍军人健康管理局为糖尿病患者提供的为期12个月的初级保健服务的质量、成本和结果。
一项使用退伍军人健康管理局行政数据和社区护理索赔的横断面研究。采用逆概率加权回归调整进行校正分析，以平衡患者特征。
在退伍军人健康管理局或社区接受初级保健服务的糖尿病退伍军人。
质量指标包括糖化血红蛋白检测、眼部检查、微量白蛋白尿检测和流感疫苗接种。通过非卧床护理敏感疾病（ACSC）的住院情况来衡量结果。对退伍军人健康管理局和社区门诊护理、住院护理及处方药的费用进行了测量。
有652,648名退伍军人健康管理局患者和3650名社区护理患者。与社区护理患者相比，退伍军人健康管理局患者中白人的比例较低，到退伍军人健康管理局初级保健机构的平均驾车时间较短，且居住在农村地区的可能性较小。在校正分析中，与退伍军人健康管理局组相比，社区护理患者接受糖化血红蛋白检测、眼部检查、微量白蛋白尿检测和流感疫苗接种的概率显著较低。ACSC住院概率没有差异。社区护理患者的平均总成本较高（1741美元[95%置信区间，431美元，3052美元]），这是由较高的住院和处方药成本导致的，但急诊护理成本低于退伍军人健康管理局患者。
接受社区初级保健服务的患者的糖尿病护理质量比接受退伍军人健康管理局初级保健服务的患者更差，成本更高。健康结果没有差异。综合医疗服务系统提供的护理在质量和价值方面可能具有优势。
