The Veterans Secretariat (VA) operates one of the largest health systems in the United States, providing treatment to millions of veterans each year. With passage Choice 2014 and Mission In 2018, Veterans who cannot receive VA treatment due to distance, waiting time or service availability can be treated in the community from a non -VA provider.
This improves accessibility to treatment, but it is not clear whether the quality or adjustment is improved. In fact, the research is a VA management Excellent quality You can draw by using a provider other than the network. Nursing sculpture. If you better understand how non -VA treatment affects future use of VA and non -VA treatment, VA leadership can focus on providing Veterans with high -quality cost -effective treatment.
New evidence
The evaluator of the PEPREC (Partnered Evidence Resource Center) recently announced. paper ~ Academic emergency medicine Title: “Use of the Community Management Emergency Room and Special Treatment of Veterans Health Bureau.” The goal of this white paper was to add it to the dialogue of medical leaks (when medical care was provided outside of the health system, it was meaningful by studying whether the use of VA emergency treatment was more subsequent VA special treatment than VA emergency treatment.
methods
The author used the subsequent cohort research design to assess the effect of using non -VA emergency treatment on subsequent non -VA specialty treatment. They collected VA administration and filed data from VA Corporate Data Warehouse. The study period was from January 2021 to July 2021, including a Veterans who had at least one emergency room (VA or non -VA) for the first three months of the study period. After using the specific exclusion criteria, 330,547 veterans were included in the sample.
They used the current procedure terms (CPT) code and provider classification to identify the specialized fields of subsequent care. The author has excluded visits to primary care, mental health care, inpatient environment, and various rehabilitation and extended accommodations to focus on the professional treatment that can be taken in -house.
In order to estimate the effect and perform sensitivity analysis, the author used a second -level minimum square model, tool variable approach and a general minimum square model. We have controlled various factors such as veteran age, gender, VA priorities, companion conditions, race and ethnicity, the closest VA medical center, VA medical center complexity and VA medical center fixed effect.
result
VA ED visits were related to subsequent VA professional treatment in all periods (30, 60, 90 and 120 days) compared to VA ED visits. The 30 -day period showed the biggest difference (45 percentage points).
In the case of Veterans who lived within 60 minutes after VA professional treatment, visiting rather than VA was more related to subsequent VA specialty treatment. The average driving time for primary and special treatment was higher for Veterans who had no visits. The ratio of non -Heathpanic white veterans and rural veterans was higher among those who visited non -regular visits than VA ED.
Finally, the author found that Increase Va Ed Physician ability is A decrease The possibility of a veteran to be treated as an amulet.
conclusion
A notable limit of this study is the difference between VA and non -VA management systems. Providers have a variety of data creation processes and financial incentives, making it difficult to compare.
Considering the amount of VA spent on non -VA every year, it is important to change policies that can reduce financial footsteps. For example, the author found that if the VA ED converts 5 percentage points to non -VA ED, non -VA nursing expenditures can increase $ 769 million. One is the same size movement the opposite The direction can lead to $ 773 million savings.
Therefore, the results of this study revealed how to receive treatment at non -VA ED increases the likelihood of a veteran receiving professional treatment in a non -VA environment. Understanding the management path provides a new way to reduce expenditure for VA policymakers. For example, if VA can provide more emergency room nursing, VA can save significant amounts in both ED CARE and Specialty Care subsequent visits. VA CARE is known to be both High quality and preference By veterans, incentives are so powerful to minimize unnecessary non -VA ED and professional treatment. This will not only produce financial savings, but also provide more non -VA treatment for Veterans, not just an option.
peprecVeterans Health Administration’s support for quality improvement research in most of its funds is to participate in health economists, health services and public health researchers, statistical programmers and policy analysts to improve the lives of veterans through evidence -based innovation using high -end bilateral methods. This is the team of the analyst.
