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2019 HSR&D/QUERI National Conference Abstract

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1001 — Veterans' Experiences with Health Care Delivered in VHA vs. through VHA Purchased Care

Lead/Presenter: Megan Vanneman,  COIN - Salt Lake City
All Authors: Vanneman ME (Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City), Wagner TH (Health Economics Resource Center, Palo Alto), ; Shwartz M (Center for Healthcare, Organization, and Implementation Research, Boston); Meterko M (Office of Reporting, Analytics, Performance, Improvement and Deployment, Bedford); Bradshaw L (Office of Reporting, Analytics, Performance, Improvement and Deployment, Bedford); Francis J (Office of Reporting, Analytics, Performance, Improvement and Deployment, Washington DC); Greenstone CL (Office of Community Care, Washington DC); Suo Y (Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City); Rosen AK (Center for Healthcare, Organization, and Implementation Research, Boston)

Objectives:
In 2014, the Veterans Health Administration (VHA) created the Veterans Choice Program to increase timely access to health care. The program purchased care through private Community Care (CC) networks. We compared the experiences of Veterans receiving specialty, primary, and mental health care in VHA and CC.

Methods:
We analyzed quarterly Fiscal Year (FY2016q2-FY2017q4) data from the VHA Survey of Healthcare Experiences of Patients (SHEP), which is comparable to the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We used t-tests and multivariate regression models to study composite measures of access, communication, and coordination (1 = never, 2 = sometimes, 3 = usually, 4 = always), and a single-item overall rating of healthcare provider (0 = worst to 10 = best). Setting of care (VHA or CC), time (quarter), and an interaction effect for setting*quarter were key independent variables. Models included a fixed effect for VHA facility and controls for individual-level sociodemographic and comorbidity characteristics. There were approximately 129,000 specialty, 141,507 primary, and 7,000 mental health care survey respondents per model.

Results:
Average communication, coordination, and provider rating scores were higher in VHA than CC for specialty, primary, and mental health care at all 7 time points, and significantly higher in 60 out of 63 cases. Access scores were mixed; they were significantly higher in CC than VHA in 5 out of 7 periods for specialty care and for 3 out of 7 periods for mental health care, while they were higher in VHA than CC for all 7 periods for primary care.

Implications:
VHA outperformed CC across all measures and types of care except access for specialty care at most time points and access to mental health care at some time points. Our findings suggest that access issues may explain why some Veterans may choose to use CC versus VHA.

Impacts:
Veteran-reported performance of VHA and CC health care is an important indicator of healthcare quality, which should be considered when planning healthcare delivery. This detailed study of Veterans' experience over time provides leadership and policy makers with data on groups (by facility and individual characteristics) whose experience with VHA and CC can be improved with focused efforts.