County-level Predictors of Growth in Community-based Primary Care Use Among Veterans.

Autor:	Gordon SH; Partnered Evidence-Based Policy Resource Center, VA Boston Medical Center.; Department of Health Law, Policy, and Management, Boston University School of Public Health., Beilstein-Wedel E; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System., Rosen AK; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System.; Department of Surgery, Boston University School of Medicine, Boston, MA., Zheng T; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System.; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine., Kelley AT; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System.; Department of Internal Medicine, Division of General Internal Medicine., Cook J; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System.; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT., Zahakos SS; Department of Health Law, Policy, and Management, Boston University School of Public Health., Wagner TH; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park CA.; Stanford University Department of Surgery, Palo Alto CA., Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System.; Department of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine.; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2021 Jun 01; Vol. 59 (Suppl 3), pp. S301-S306.
DOI:	10.1097/MLR.0000000000001555
Abstrakt:	Background: The 2014 Choice Act expanded the Veterans Health Administration's (VA) capacity to purchase services for VA enrollees from community providers, yet little is known regarding the growth of Veterans' primary care use in community settings. Objectives: The aim was to measure county-level growth in VA community-based primary care (CBPC) penetration following the Choice Act and to assess whether CBPC penetration increased in rural counties with limited access to VA facilities. Data and Sample: A total of 3132 counties from VA administrative data from 2015 to 2018, Area Health Resources Files, and County Health Rankings. Analysis: We defined the county-level CBPC penetration rate as the proportion of VA-purchased primary care out of all VA-purchased primary care (ie, within and outside VA). We estimated county-level multivariate linear regression models to assess whether rurality and supply of primary care providers and health care facilities were significantly associated with CBPC growth. Results: Nationally, CBPC penetration rates increased from 2.7% in 2015 to 7.3% in 2018. The rurality of the county was associated with a 2-3 percentage point (pp) increase in CBPC penetration growth (P<0.001). The presence of a VA facility was associated with a 1.7 pp decrease in CBPC penetration growth (P<0.001), while lower primary care provider supply was associated with a 0.6 pp increase in CBPC growth (P<0.001). Conclusion: CBPC as a proportion of all VA-purchased primary care was small but increased nearly 3-fold between 2015 and 2018. Greater increases in CBPC penetration were concentrated in rural counties and counties without a VA facility, suggesting that community care may enhance primary care access in rural areas with less VA presence. Competing Interests: The authors declare no conflict of interest. (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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