Primary Care Spending in the Veterans Health Administration in 2014 and 2018

Reddy, Ashok; Nelson, Karin M.; Wong, Edwin S.

doi:10.1001/jamanetworkopen.2021.17533

Cited by 4 publications

(3 citation statements)

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“…Nearly two-thirds of enrollees were non-Hispanic White, 20.4% non-Hispanic Black, 6.7% Hispanic, and 4.5% “other.” These demographics on age, gender, and race/ethnicity are similar to VHA total population. 28 , 29 HT enrollees had an average Gagne score of 1.35 (SD=2.36) and a drive time of 22 min (SD=23.6) to the nearest VHA facility. The average neighborhood SES index decile was 4.18 (SD=2.86) and 59.3% of patients lived in urban locations.…”

Section: Resultsmentioning

confidence: 99%

Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017

et al. 2022

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Background Home telehealth (HT) programs enable communication and remote monitoring of patient health data between clinician visits, with the goal of improving chronic disease self-management and outcomes. The Veterans Health Administration (VHA) established one of the earliest HT programs in the country in 2003; however, little is known about how these services have been utilized and expanded over the last decade. Objective To describe trends in use of VHA’s HT program from 2010 through 2017 and correlates of length of enrollment in HT services. Design Retrospective observational cohort study. Participants Patients enrolled in HT between January 1, 2010 and December 31, 2017. Main Measures We described the number and characteristics of patients enrolled in HT, including the chronic conditions managed. We also identified length of HT enrollment and examined patient and facility characteristics associated with longer enrollment. Key Results The total number of patients enrolled in HT was 402,263. At time of enrollment, half were >65 years old, 91% were male, and 59.3% lived in urban residences. The most common conditions addressed by HT were hypertension (28.8%), obesity (23.9%), and diabetes (17.0%). The median time to disenrollment in HT was 261 days (8.6 months) but varied by chronic condition. In a multivariable Cox proportional hazards model, covariates associated with higher likelihood of staying enrolled were older age, male gender, non-Hispanic Black race/ethnicity, lower neighborhood socioeconomic status, living in a more rural setting, and a greater burden of comorbidities per the Gagne index. Conclusions Across 8 years, over 400,000 veterans engaged in HT services for chronic disease management and over half remained in the program for longer than 8 months. Our work provides a real-world evaluation of HT service expansion in the VHA. Additional studies are necessary to identify optimal enrollment duration and patients most likely to benefit from HT services.

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Section: Resultsmentioning

confidence: 99%

Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017

et al. 2022

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“… 12 Vaccination age strata diverged slightly from those of the Centers for Disease Control and Prevention (CDC), given the older population of the VHA compared with the United States overall (the median age of VHA enrollees is 65 years [interquartile range 50–73 years]). 13 The VHA also differed by recommending priority vaccination for specific groups at risk of severe Covid-19 disease or of viral exposure because of frequent contact with health care (e.g., hemodialysis, spinal cord injury, hospital-based chemotherapy, and solid-organ transplant) or communal dwelling status (e.g., nursing home resident or persons experiencing homelessness). Approximately 1 month in advance of our facility’s first administered Covid-19 vaccination in December 2020, we assembled a team to develop a facility-level framework for an equitable vaccine delivery strategy.…”

Section: The Executionmentioning

confidence: 99%

Best Practices for an Equitable Covid-19 Vaccination Program

et al. 2021

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“…PCP turnover is a major concern for the Veterans Health Administration (VHA), as one of the largest integrated health care systems in the country serving over 6 million veterans in more than 900 primary care clinics (Reddy et al, 2021). In 2010, the VHA transformed primary care delivery based on the patient-centered medical home (PCMH) model, called the Patient-Aligned Care Team (PACT) initiative.…”

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Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home

Reddy

Maynard

Kaboli

et al. 2023

Journal of Ambulatory Care Management

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Understanding which factors predict primary care provider (PCP) turnover can help organizations prepare for PCP shortages. We conducted a retrospective cohort study of Veteran Health Administration PCPs between 2012 and 2016. We analyzed whether 7 domains of the patient centered medical home (PCMH) implementation-including access, care coordination, comprehensiveness, self-management support, communication, shared decision-making, and team-based care-were associated with PCP turnover. We found that 2 domains of PCMH (access and self-management) were associated with lower turnover, which may reflect that practice cultures that support these characteristics may lower PCP turnover.

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Primary Care Spending in the Veterans Health Administration in 2014 and 2018

Abstract: 30% is spent on outpatient services, but specific data for primary care spending are unknown. 6 Our results suggest opportunities to increase investment in primary care to improve care for veterans.

Cited by 4 publications

References 5 publications

Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017

Home Telehealth in the Veterans Health Administration: Trends and Correlates of Length of Enrollment from 2010 to 2017

Best Practices for an Equitable Covid-19 Vaccination Program

Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home

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