VA Community-Based Outpatient Clinics

Hedeen, Ashley N.; Heagerty, Patrick J.; Fortney, John C.; Borowsky, Steven J.; Walder, Debby J.; Chapko, Michael K.

doi:10.1097/00005650-200207000-00003

Cited by 17 publications

(5 citation statements)

References 6 publications

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“…In a series of evaluations of patient satisfaction, quality of care, utilization, and expenditures, veterans obtaining VA primary care at community clinics (community‐based patients) were compared with veterans obtaining primary care at VA hospital outpatient clinics (hospital‐based patients). Satisfaction and quality of care were found to be comparable between community‐based and hospital‐based patients (Borowsky et al 2002; Hedeen et al 2002). Community‐based patients had more primary care visits; were less likely to use specialty, mental health, and ancillary and inpatient care in VA compared with hospital‐based patients (Fortney et al 2002); and had lower VA outpatient care costs and total VA costs (Maciejewski et al 2002, 2007).…”

Section: Introductionmentioning

confidence: 98%

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Liu

Chapko

Bryson

et al. 2010

Health Services Research

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Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.

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Section: Introductionmentioning

confidence: 98%

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Liu

Chapko

Bryson

et al. 2010

Health Services Research

Self Cite

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show abstract

“…Referrals to another facility to obtain contraception could incur significant opportunity costs for patients in time and travel. On the other hand, previous work has shown that the proportion of female patients is smaller at CBOCs than at their parent VA facility, 36,37 which may, in part, account for the smaller likelihood and need that IUD services be available onsite. Certainly there exists a tension between the need to provide access to a contraceptive service and the need to ensure high‐quality care for a procedure with volume‐related competency standards.…”

Section: Discussionmentioning

confidence: 95%

Determinants of contraceptive availability at medical facilities in the department of veterans affairs

et al. 2006

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VA's provision of hormonal and intrauterine contraception is in accordance with community standards, although onsite availability is not universal. Although contraception is a crucial component of a woman's health maintenance, her ability to obtain certain contraceptives from the facility where she obtains her primary care is largely influenced by the availability of a gynecologist. Further research is needed to determine how fragmentation of women's care into reproductive and nonreproductive services impacts access to contraception and the incidence of unintended pregnancy.

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“…37 The hospitalisation rate for diabetes was employed as an important indicator for evaluating the quality of PHC services in several studies. [38][39][40] In addition to PHC services, health insurance policies may also affect hospitalisation rates among patients with diabetes in China. To assess this effect, we have included the type of insurance plan in our regression analysis and found that there was no significant differences in hospitalisation rates between noninsured and those insured by different insurance plans.…”

Section: Discussionmentioning

confidence: 99%

Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database

et al. 2020

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ObjectiveTo assess the quality of primary healthcare (PHC) for patients with diabetes in China from 2011 to 2015.SettingThis study analysed data on 1006, 1472 and 1771 participants with diabetes who were surveyed in 2011, 2013 and 2015, respectively, in the China Health and Retirement Longitudinal Study, a nationally representative survey conducted in 29 provinces of China.Outcome measuresThe study measured the proportions of patients with diabetes who received diabetes-related health education, examinations and treatments, as well as the hospital admission rate due to diabetes of these patients. Multilevel logistic regression was used to adjust sociodemographic variables.ResultsAccording to the multivariate analysis, the proportion of patients who received diabetes-related health education decreased significantly (OR=0.74, 95% CI 0.61 to 0.90), and the proportion of those receiving examinations and treatments remained unchanged from 2011 to 2015. Diabetes-related hospitalisation increased from 4.01% in 2011 to 6.08% in 2013 (OR=1.47, 95% CI 0.97 to 2.22), and recurrent hospitalisations increased from 18.87% in 2011 to 28.45% in 2015 (OR=1.78, 95% CI 1.44 to 2.20). The proportions of patients with diabetes-related and recurrent hospitalisations in western China were higher than those in the east (OR=1.80, 95% CI 1.13 to 2.87; OR=1.92, 95% CI 1.50 to 2.45).ConclusionsNationally, the analysis of patient-reported process and outcome indicators cannot confirm that the quality of PHC has improved in China during 2011–2015. Regional disparities in primary diabetes care require urgent resource allocation to western China. Establishing a national quality registry for PHC, which transparently reports outcomes by region and social-economic position, is essential for countries sharing the challenge of improving both quality and equity of PHC.

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VA Community-Based Outpatient Clinics

Cited by 17 publications

References 6 publications

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Determinants of contraceptive availability at medical facilities in the department of veterans affairs

Assessing the quality of primary healthcare for diabetes in China: multivariate analysis using the China Health and Retirement Longitudinal Study (CHARLS) Database

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