Abstract
Abstract
Background
Through Community Care Networks (CCNs) implemented with the VA MISSION Act, VA expanded provider contracting and instituted network adequacy standards for Veterans’ community care.
Objective
To determine whether early CCN implementation impacted community primary care (PC) appointment wait times overall, and by rural/urban and PC shortage area (HPSA) status.
Design
Using VA administrative data from February 2019 through February 2020 and a difference-in-differences approach, we compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs. We ran regression models with all appointments, and stratified by rural/urban and PC HPSA status. All models adjusted for Veteran characteristics and VA facility–level clustering.
Appointments
13,720 CCN and 40,638 comparison appointments.
Main Measures
Wait time, measured as number of days from authorization to use community PC to a Veteran’s first corresponding appointment.
Key Results
Overall, unadjusted wait times increased by 35.7 days ([34.4, 37.1] 95% CI) after CCN implementation. In adjusted analysis, comparison wait times increased on average 33.7 days ([26.3, 41.2] 95% CI, p < 0.001) after CCN implementation; there was no significant difference for CCN wait times (across-group mean difference: 5.4 days, [−3.8, 14.6] 95% CI, p = 0.25). In stratified analyses, comparison wait time increases ranged from 29.6 days ([20.8, 38.4] 95% CI, p < 0.001) to 42.1 days ([32.9, 51.3] 95% CI, p > 0.001) after CCN implementation, while additional differences for CCN appointments ranged from 13.4 days ([3.5, 23.4] 95% CI, p = 0.008) to −15.1 days ([−30.1, −0.1] 95% CI, p = 0.05) for urban and PC HPSA appointments, respectively.
Conclusions
After early CCN implementation, community PC wait times increased sharply at VA facilities that did and did not implement CCNs, regardless of rural/urban or PC HPSA status, suggesting community care demand likely overwhelmed VA resources such that CCNs had limited impact.
Funder
U.S. Department of Veterans Affairs
Health Services Research and Development
Publisher
Springer Science and Business Media LLC
Reference48 articles.
1. Doty M, Shah A, Fields K, et al. Comparing Nations on Timeliness and Coordination of Health Care. Findings from the 2021 Commonwealth Fund Health Policy Survey of Older Adults. Commonwealth Fund. Available at: https://www.commonwealthfund.org/sites/default/files/2021-10/PDF_Doty_timeliness_coordination_2021_intl_survey_older_adults_chartpack_v2.pdf. Accessed 22 June 2022.
2. Veterans Health Administration. About VHA. Available at: https://www.va.gov/health/aboutvha.asp. July 2019. Accessed 5 Dec 2021.
3. Bagalman E. The Number of Veterans That Use VA Health Care Services: A Fact Sheet. Congressional Research Service; 2014. Available at: https://fas.org/sgp/crs/misc/R43579.pdf. Accessed 7 Dec 2021.
4. Centers for Medicare and Medicaid Services Alliance to Modernize Healthcare. Independent Assessment of the Health Care Delivery Systems and Management Processes of the Department of Veterans Affairs, Volume I: Integrated Report. McLean, VA: MITRE Corporation; 2015:168. Available at: https://www.va.gov/opa/choiceact/documents/assessments/Integrated_Report.pdf. Accessed 7 Dec 2021.
5. Veterans Affairs Office of Budget. FY 2017 Budget Submission. U.S. Department of Veterans Affairs; 2017. Available at: https://www.va.gov/budget/products.asp. Accessed 7 Dec 2021.
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献