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Fall 2024
Note: An earlier edition of this newsletter contained an incorrect URL for the ACCENT CORE website. This edition has been corrected.
—The Editors
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ACCENT is a nationwide network of VA researchers and operations partners, fostering collaboration and knowledge diffusion in the areas of Access and Community Care among VA investigators, VA Operational Partners, VISN and VA facility leadership, and VA Health Systems Research to support and inform national priorities for achieving high-quality and timely access to care. ACCENT extends the work initiated by the Community Care Research Evaluation and Knowledge (CREEK) Center and the Veterans Access Research Consortium (VARC).
View the recording of the ACCENT CORE CIDER Cyberseminar (held February 12, 2024) Introducing the Access and Community Care Engagement Network Team (ACCENT)
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Interested in receiving the quarterly ACCENT CORE newsletter? Email VHAACCENTCORE@va.gov
New research published or presented at a conference? Please let us know so we can share it with the community in our next newsletter. Email VHAACCENTCORE@va.gov
Email accent.data@va.gov if you have questions for the ACCENT data team.
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Visit our New Website!
Check out the new ACCENT website, where you will find funded projects, recently published papers, minutes from monthly calls with the VA Office of Integrated Veteran Care (IVC), information about using community care data captured in the Consolidated Data Set and Program Integrity Tool, and information about current access- and community care-related programs and projects.
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Upcoming ACCENT CORE Webinar!
November 4, 2024 at 2:00 ET
Veterans' Access to Birth Support Services Through an Innovative Doula Pilot Program in New Orleans and Durham
Dr. Kristin Mattocks
VA Central Western Massachusetts
NEWS FROM OPERATIONAL PARTNERS
Our operational partners would like you to reach out to Kristin Mattocks with ACCENT CORE if you need a letter of support for a new project submission, CDA, or grant proposal related to Access and Community Care.
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ACCENT Veteran and Caregiver Engagement Panel Updates
Are you a researcher or someone interested in working to improve access to VA?
Consider incorporating feedback from those who will be affected by your research. ACCENT is launching a Veteran and Caregiver Engagement Panel (VCEP) as an opportunity for access and community care researchers to integrate Veterans’ and Caregivers’ perspectives into the research design, methods, and dissemination of your research.
VCEP has already recruited a diverse cohort of Veterans for the group and is looking to add more. They are planning to hold their first VCEP panel meeting in October 2024.
Contact Kenda Steffensmeier to schedule a time to meet with the ACCENT VCEP!
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The study examines changes in hospitalization trends and healthcare utilization among Veterans following the MISSION Act implementation using data from VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. We used a retrospective cohort of Veterans with active VA primary care utilization and ≥ 1 acute hospitalization between 1/1/2016 and 12/31/2021 to compare 7- and 30-day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA-funded stay in community facility (CC), or Medicare-funded community stay (CMS)). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. Our study showed that the MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post-implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post-implementation risk of ED utilization following CC admissions was estimated to be lower compared to VHA index admissions. Reasons for this divergence require further investigation.
For inquires, contact either: Mulugeta Gebregziabher, PhD or Neal Axon, MD, MSCR, both of the Health Equity and Rural Outreach Innovation Center.
Axon, R. N., Ward, R., Mohamed, A., Pope, C., Stephens, M., Mauldin, P. D., & Gebregziabher, M. (2024). Trends in Veteran hospitalizations and associated readmissions and emergency department visits during the MISSION Act era. Health Services Research. https://doi.org/10.1111/1475-6773.14332
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This project estimated national changes in outpatient visits provided through VA-direct and VA-purchased community care before and after the MISSION Act and the COVID-19 pandemic, fiscal years 2018-2021. Purchased-care visits increased by 107% for primary care, 167% for mental health, and 129% for emergency/urgent care over the 4-year period. After the MISSION Act, there was a significant increase in the share of clinic visits in the community for emergency/urgent care and mental health care but not primary care. Rural clinics had larger increases in the share of visits in the community for primary care and emergency/urgent care compared to urban clinics. These findings highlight the considerable growth in purchased care, especially in rural areas.
For inquiries, contact: Jean Yoon, PhD,
VA Health Economics Resource Center.
Yoon, J., Gujral, K., Dismuke-Greer, C., Scott, J. Y., & Jiang, H. (2024). Growth of community outpatient care in the Veterans Affairs system after the MISSION Act. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08787-7
This project compared the quality, costs, and outcomes of community and VA-provided primary care for patients with diabetes over a 12-month episode. VA patients were less likely to be White, had shorter mean drive time to VA primary care, and were less likely to be rural than community care patients. After balancing patient characteristics across both groups, community care patients had significantly lower probability of hemoglobin A1C tests, eye exams, microalbumin urine tests, and flu shots compared to VA patients. There was no difference in probability of hospitalization for an ambulatory care sensitive condition. Community care patients had higher mean total costs ($1,741 [95% CI: $431, $3052]), driven by higher inpatient and prescription drug costs but lower emergency care costs, than VA patients. Care in the VA integrated delivery system may have advantages in quality and value.
For inquiries, contact: Jean Yoon, PhD,
VA Health Economics Resource Center.
Yoon, J., Chow, A., Jiang, H., Wong, E., & Chang, E. T. (2024). Comparing quality, costs, and outcomes of VA and community primary care for patients with diabetes. Journal of General Internal Medicine.
https://doi.org/10.1007/s11606-024-08968-4
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Axon, R. N., Ward, R., Mohamed, A., Pope, C., Stephens, M., Mauldin, P. D., & Gebregziabher, M. (2024). Trends in Veteran hospitalizations and associated readmissions and emergency department visits during the MISSION Act era. Health Services Research. https://doi.org/10.1111/1475-6773.14332
Brown, T., Fagerlin, A., Samore, M. H., Harris, A. H. S., Galyean, P., Zickmund, S., Pettey, W. B. P., & Vanneman, M. E. (2024). Information and resources VA health system leaders need to manage enrollment and retention for Post‐9/11 veterans. Health Services Research. https://doi.org/10.1111/1475-6773.14351
Dizon, M. P., Chow, A., Ong, M. K., Phibbs, C. S., Vanneman, M. E., Zhang, Y., & Yoon, J. (2024). Lower comorbidity scores and severity levels in Veterans Health Administration hospitals: a cross-sectional study. BMC Health Services Research, 24(1). https://doi.org/10.1186/s12913-024-11063-3
Feyman, Y., Griffith, K. N., Dorneo, A., Simmons, S. F., Roumie, C. L., & Mattocks, K. M. (2024). Physicians and specialties in the Veterans Health Administration’s community care network. JAMA Network Open, 7(5), e2410841. https://doi.org/10.1001/jamanetworkopen.2024.10841
Kelley, A. T., Torre, M. P., Wagner, T. H., Rosen, A. K., Shwartz, M., Lu, C.-C., Brown, T. K., Zheng, T., Beilstein-Wedel, E., & Vanneman, M. E. (2024). Trends in bundled outpatient behavioral health services in VA-direct versus VA-purchased care. Administration and Policy in Mental Health. https://doi.org/10.1007/s10488-024-01404-z
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Krishnamurthy, S., Li, Y., Sileanu, F., Essien, U. R., Vanneman, M. E., Mor, M., Fine, M. J., Thorpe, C. T., Radomski, T., Suda, K., Gellad, W. F., & Roberts, E. T. (2024). Racial and ethnic differences in health care experiences for Veterans receiving VA community care from 2016 to 2021. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08818-3
O’Hanlon, C. E., Zeliadt, S. B., DeFaccio, R., Gaj, L., Bokhour, B. G., & Taylor, S. L. (2024). Patient-reported pain and physical health for acupuncture and chiropractic care delivered by Veterans Affairs versus community providers. PloS One, 19(5), e0303651. https://doi.org/10.1371/journal.pone.0303651
Rosen, A. K., Beilstein-Wedel, E., Shwartz, M., Davila, H., & Gurewich, D. (2024). Racial and ethnic and rural variations in access to primary care for veterans following the MISSION Act. JAMA Health Forum, 5(6), e241568. https://doi.org/10.1001/jamahealthforum.2024.1568
Wagner, T. H., Schmidt, A., Belli, F., Aouad, M., Gehlert, E., Desai, M., Graham, L., & Rose, L. (2024). Health insurance enrollment among US veterans, 2010-2021. JAMA Network Open, 7(8), e2430205. https://doi.org/10.1001/jamanetworkopen.2024.30205
Yoon, J., Chow, A., Jiang, H., Wong, E., & Chang, E. T. (2024). Comparing quality, costs, and outcomes of VA and community primary care for patients with diabetes. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08968-4
Yoon, J., Gujral, K., Dismuke-Greer, C., Scott, J. Y., & Jiang, H. (2024). Growth of community outpatient care in the Veterans Affairs system after the MISSION Act. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08787-7
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