The Role of VA Community Care in Addressing Health and Health Care Disparities

Yehia, Baligh R.; Greenstone, Clinton L.; Hosenfeld, Christina; Matthews, Kameron L.; Zephyrin, Laurie

doi:10.1097/mlr.0000000000000768

Cited by 5 publications

(6 citation statements)

References 3 publications

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“…5,6 For these reasons, rural Veterans have historically relied more heavily on non-VHA care than their urban counterparts. 7 To help address the unique needs of rural Veterans, VHA undertook several initiatives: the Office of Rural Health was established in 2006; Community-based Outpatient Clinics were implemented in rural areas; reimbursements were allotted to Veterans for travel to VHA facilities for care; and investments were made in telehealth services to rural Veterans. 8,9 Expansion of CC is another potential mechanism for improving access to care.…”

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confidence: 99%

“…Increased access to CC has the potential to benefit rural Veterans in particular, who often face obstacles obtaining care at VHA due to greater geographic and distance barriers, hospital closings, and provider shortages 5,6. For these reasons, rural Veterans have historically relied more heavily on non-VHA care than their urban counterparts 7. To help address the unique needs of rural Veterans, VHA undertook several initiatives: the Office of Rural Health was established in 2006; Community-based Outpatient Clinics were implemented in rural areas; reimbursements were allotted to Veterans for travel to VHA facilities for care; and investments were made in telehealth services to rural Veterans 8,9.…”

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confidence: 99%

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Did Access to Care Improve Since Passage of the Veterans Choice Act?

et al. 2021

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confidence: 99%

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confidence: 99%

Did Access to Care Improve Since Passage of the Veterans Choice Act?

et al. 2021

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“…With respect of health outcomes [ 21 ], our study supports other reports describing that although Black subjects are more likely to be hospitalized, the increased risk of death for Black patients is attenuated by hospitalization, the inclusion of comorbidities, social deprivation, and vaccination status. Yehia et al described that among hospitalized patients, the Black-White difference in mortality disappeared after adjusting for demographic characteristics, comorbidities, and neighborhood deprivation [ 22 ]. Other analyses have revealed that increased mortality risk among Black patients is attenuated by hospitalization [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries

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Palacio

Chen

et al. 2022

J. Racial and Ethnic Health Disparities

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Background COVID-19 disproportionately impacts the elderly, particularly racial/ethnic minorities and those with low socioeconomic status (SES). These latter groups may also have higher vaccine hesitancy. We aim to evaluate if access to care improves COVID-19 vaccination rates and improves health disparities. Methods We conducted a retrospective cohort study of Medicare patients receiving care in a high-touch capitated network across ten states. We collected type and date of COVID-19 vaccine and demographic and clinical data from the inpatient and outpatient electronic health records and socioeconomic status from the US census. Our primary outcome was completing vaccination using logistic regression. Results Our cohort included 93,224 patients enrolled in the network during the study period. Sixty nine percent of all enrolled patients completed full vaccination. Those who completed vaccination did it with Pfizer (46%), Moderna (49%), and Jannsen (4.6%) vaccines. In adjusted models, we found that the following characteristics increased the odds of being vaccinated: being male, increasing age, BMI, and comorbidities, being Black or Hispanic, having had the flu vaccine in 2020, and increasing number of office primary care visits. Living in a neighborhood with higher social deprivation and having dual Medicaid/Medicare enrollment decreased the odds of completing full vaccination. Conclusions Increasing office visit in a high-touch primary care model is associated with higher vaccination rates among elderly populations who belong to racial/ethnic minorities or have low socioeconomic status. However, lower SES and Medicaid populations continue to have difficulty in completing vaccination. Key points • High COVID-19 vaccination rates of minorities enrolled in Medicare can be achieved. • Lower socioeconomic status is associated with completing vaccination. • Increasing office visits can lead to higher vaccination rates. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01343-1.

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“…We build on Vanneman and colleagues seminal work by focusing specifically on rural Veterans’ experiences in CC, a critical issue given that rural Veterans represent about 30% of all VA enrollees, yet comprised 39% of Veterans who used CC in Fiscal Year (FY) 15 and FY16. 12 We used data from the Survey of Healthcare Experiences of Patients (SHEP) to: (1) compare rural and urban Veterans’ experiences with outpatient care in CC and VA; (2) compare rural Veterans’ experiences with outpatient care in CC and VA in FY16 (early in the post-Choice period) and FY19 (the most recent year SHEP data were available); and (3) assess whether rural Veterans’ experiences in CC changed over time. We hypothesized that: (1) rural Veterans would report worse experiences with care in CC than their urban counterparts; (2) rural Veterans would report worse experiences with care in CC than in VA; and (3) rural Veterans’ experiences in CC would improve over time.…”

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confidence: 99%