Community Urgent Care Use Following Implementation of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act

Abstract

Background: Effective June 6, 2019, Veterans Affairs (VA) began offering a new urgent care (UC) benefit that provides eligible Veterans with greater choice and access to care for the treatment of minor injuries and illnesses in their local communities. Objectives: The aim was to describe trends in UC use, identify predictors of UC benefit use, and understand the factors associated with community UC use versus VA emergency department (ED) or urgent care center (UCC) use. Study Design: Using VA administrative data, this was a retrospective cross-sectional study of Veterans that were enrolled in VA in FY19. Veterans were classified into 3 groups: UC benefit users, benefit non-users, and VA ED/UCC users. Methods: We used summary statistics to compare population characteristics across user groups. To determine whether predisposing, enabling, and need factors predicted UC benefit use and setting choice (community UCC vs. VA ED/UCC), 2 logistic regression models were fitted to assess odds of UC use. Results: From June 6, 2019 through February 29, 2020, 138,305 Veterans made 175,821 community UC visits. The majority of visits were made by White males who were not subject to co-pays. The average cost to VA for UC visits was $132 (SD=$135). Upper respiratory infections were the most common reason for UC use. Being younger, female, and living farther from a VA ED/UCC was associated with greater UC benefit use compared with both benefit non-users and VA ED/UCC users. Conclusions: The new benefit expands Veteran access to UC services for low-acuity conditions.

Disparities in Wait Times for Care Among US Veterans by Race and Ethnicity

“…This finding also suggests a need for further inquiry and interventions. For example, White veterans disproportionately use community care compared with those who identify as Black or other races or ethnicities, 56 , 57 and community care is associated with comparatively longer wait times than the VHA. 18 , 20 , 58 , 59 Thus, facilities where White veterans wait longer than Black or Hispanic veterans may indicate needed improvements in access to community care.…”

Standard nurse phone triage versus tele–emergency care pilot on Veteran use of in‐person acute care: An instrumental variable analysis

“…The most common nurse triage concerns in our study-musculoskeletal pain, cough/URI, urinary problems, rash, shortness of breath, abdominal pain, and chest pain-are similar to the most common reasons for Veteran visits to community urgent care centers as well as ED visits more generally. 25,26 There was significant variation in which conditions went on to have a tele-EC visit, indicating a degree of selection bias, though we did not examine whether this was driven by patient, nurse, or physician preference. Tele-EC physicians indicated they were able to resolve the Veteran's concern in a majority of encounters, though this was not uniform across conditions.…”

Hospital‐level variation in risk‐standardized admission rates for emergency care–sensitive conditions among older and younger Veterans

“…Given the increasing role of emergency care within the VA, this will be of great interest to inform efforts seeking to align resource investment to achieve optimal health outcomes 5,26 . Further, this is of particular policy relevance given increased Veteran access to non‐VA care under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act 26,69,70 . Understanding differences in variations in ED‐based admissions practices between VA and non‐VA settings will be integral when analyzing the influence of the MISSION Act on care utilization and health outcomes for Veterans.…”