Comparing VA and Community-Based Care: Trends in Sleep Studies Following the Veterans Choice Act
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Center of Innovation for Complex Chronic Health Care (CINCCH), Hines VA Hospital, Hines, IL, USA; 2Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, IL, USA; 3Center to Improve Veteran Involvement in Care, Portland VA Healthcare System, Portland, OR, USA; 4Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA; 5Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; 6 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA; 7VA Information Resource Center, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; 8Section of Academic Internal Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA; 9 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA; 10Center for Healthcare Improvement & Medical Effectiveness, San Francisco VA Healthcare System, San Francisco, CA, USA; 11College of Public Health and Human Sciences & Center for Genome Research and Biocomputing, Oregon State University, Corvallis, OR, USA; 12School of Nursing, Oregon Health and Science University, Portland, OR, USA.
BACKGROUND: To address concerns about access to care, the Veterans Access, Choice, and Accountability Act of 2014 was enacted to make care available in the community when Veterans Health Administration (VA) care was unavailable or not timely. This paper examined VA referrals for diagnostic sleep studies from federal fiscal year (FY) 2015–2018. DESIGN: Sleep studies completed between FY2015 and 2018 for Veterans tested within VA facilities (VAF) or referred to VA community care (VACC) providers were identified using VA administrative data files. Sleep studies were divided into laboratory and home studies. KEY RESULTS: The number of sleep studies conducted increased over time; the proportion of home studies increased in VAF (32 to 47%). Veterans were more likely to be referred for a sleep study to VACC if they lived in a rural or highly rural area (ORs = 1.47 and 1.55, respectively), and had public or public and private insurance (ORs = 2.01 and 1.35), and were less likely to be referred to VACC if they were age 65+ (OR = 0.72) and were in the highest utilization risk based on Nosos score (OR = 0.78). Regression analysis of sleep study type revealed that lab studies were much more likely for VACC referrals (OR = 3.16), for persons living in rural areas (OR = 1.21), with higher comorbidity scores (OR = 1.28) and for ages 44–54, 55 to 64, and 65+ (ORs = 1.12, 1.28, 1.45, respectively) compared to younger Veterans. Veterans with some or full VA copayments (ORs = 0.91 and 0.86, respectively), and overweight Veterans (OR = 0.94) were less likely to have lab studies. CONCLUSIONS: The number of sleep studies performed on Veterans increased from 2015 to 2018. Access to sleep studies improved through a combination of providing care through the Veteran Choice Program, predominantly
This work was presented at the VA HSR&D/QUERI 2019 National Conference, Washington, D.C., Oct. 29–31, 2019. Received
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