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2019 HSR&D/QUERI National Conference Abstract

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4105 — Impacts of the Transition to Community Care Under the Choice Act: Access to Sleep Testing in VA and the Community

Lead/Presenter: Frances Weaver,  COIN - Hines
All Authors: Weaver FM (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL), Weaver FM (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL), , Hickok A (Center to Improve Veterans Involvement in Care, Portland VA Healthcare System, Portland, OR) Zhang Q (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL), Prasad B (UI Health Sleep Sciences Center,University of Illinois College of Medicine) Bartle B (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL), Tarlov E (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL), Gordon HS (Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL and the Jesse Brown VA Medical Center, Chicago, IL), Taylor A (Center of Innovation for Complex Chronic Healthcare and the VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL), Young R (Center to Improve Veterans Involvement in Care, Portland VA Healthcare System, Portland, OR), Hynes DM (Center to Improve Veterans Involvement in Care, Portland VA Healthcare System)

Objectives:
As care options have expanded with the Veterans Choice and MISSION Acts, attention to Veterans' access and use of specialty services has increased. The prevalence of sleep disorders among Veterans is growing. Given the high demand for sleep testing combined with limited access to testing at some VA facilities, sleep tests are often referred to community providers. We examined referral trends in VA and the community.

Methods:
VA administrative databases were examined to identify a cohort of Veterans referred for a sleep test. CPT-4 codes were used to identify laboratory and in-home testing. Time from referral to visit was calculated based on the date the appointment was made to the visit date for VA care, and the authorization date to visit date for community care.

Results:
691,542 sleep test referrals were completed between FY15-18; 67% conducted in VA and 33% in the community. While the number of referrals increased over time, the proportion referred to the community remained relatively constant. The proportion of in-home tests done in the community remained around 20%, while VA in-home testing increased (33% to > 47%). Community referrals were more common among Veterans living in rural vs. non-rural areas (38.2% vs. 28.2%; SMD = .229). Veterans with priority status 1 were more likely to have a VA than a community referral (45% vs. 20%; SMD = .66). Time from referral/authorization to visit differed by site (median = 20 days in VA and 30 days in the community; chi-square = 16787, p < .001). Median time from referral to sleep test was 14 and 27 days for VA in-home and in-lab visits; and 21 and 34 days, respectively, in the community (p's < .001).

Implications:
One-third of sleep test referrals were made to community providers. VA increased use of in-home sleep testing, but community use remained around 20%. Time to sleep test visit appears to be shorter for referrals to VA vs. the community, and time to in-home testing is shorter than lab testing for both VA and community. However, these data should be viewed cautiously as we used administrative data.

Impacts:
The majority of Veterans referred for sleep testing had a visit to a sleep facility/provider within 30 days, regardless of location.