• Medicine · Aug 2023

    Choosing Veterans Affairs: Determinants of post-9/11 Veterans' enrollment in Veterans Affairs health care.

    • Megan E Vanneman, Matthew H Samore, Tianyu Zheng, Warren B P Pettey, Angela Fagerlin, and HarrisAlex H SAHSCenter for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA..
    • Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
    • Medicine (Baltimore). 2023 Aug 18; 102 (33): e34814e34814.

    AbstractFollowing recent policy changes, younger Veterans have particularly increased options for where to receive their health care. Although existing research provides some understanding of non-modifiable individual (e.g., age) and external community (e.g., non-VA provider supply) factors that influence VA enrollment, this study focused on modifiable facility access and quality factors that could influence Veterans' decisions to enroll in VA. In this cohort study, we examined enrollment in and use of VA services in the year following military separation as the binary outcome using mixed-effects logistic regressions, stratified by Active and Reserve Components. This study included 260,777 Active and 101,572 Reserve Component post-9/11 Veterans separated from the military in fiscal years 2016 to 2017. Independent variables included 4 access measures for timeliness of VA care and 3 VA quality measures, which are included in VA Medical Centers' performance plans. Eligible Veterans were more likely to enroll in VA when the closest VA had higher quality scores. After accounting for timeliness of VA care and non-modifiable characteristics, rating of primary care (PC) providers was associated with higher VA enrollment for Active Component (odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.007-1.020). Higher mental health (MH) continuity (OR = 1.039, 95% CI: 1.000-1.078) and rating of PC providers (OR = 1.009, 95% CI: 1.000-1.017) were associated with higher VA enrollment for Reserve Component. Improving facility-specific quality of care may be a way to increase VA enrollment. In a changing policy environment, study results will help VA leadership target changes they can make to manage enrollment of Veterans in VA and deliver needed foundational services.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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