• Jean Yoon, Adam Chow, Hao Jiang, Emily Wong, and Evelyn T Chang.
• Health Economics Resource Center (HERC), VA Palo Alto Health Care System, Menlo Park, CA, USA. Jean.Yoon@VA.gov.
• J Gen Intern Med. 2024 Aug 5.

BackgroundThe Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded access to independent community providers outside the Veterans Health Administration (VA). Little is known how quality, costs, and outcomes of primary care received in the community compare to that of the VA.ObjectiveTo compare quality, costs, and outcomes of community and VA-provided primary care for patients with diabetes over a 12-month episode.DesignA cross-sectional study using VA administrative data and community care claims. Adjusted analyses were conducted using inverse probability weighted regression adjustment to balance patient characteristics.ParticipantsVeterans with diabetes receiving primary care in the VA or community.Main MeasuresQuality measures included receipt of hemoglobin A1C tests, eye exams, microalbumin urine tests, and flu shots. Outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC). Costs were measured for VA and community outpatient care, inpatient care, and prescription drugs.Key ResultsThere were 652,648 VA patients and 3650 community care patients. 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. In adjusted analyses, community care patients had significantly lower probability of receiving a hemoglobin A1C test, eye exam, microalbumin urine test, and flu shot compared to the VA group. There was no difference in probability of an ACSC hospitalization. Community care patients had higher mean total costs ($1741 [95% CI, $431, $3052]), driven by higher inpatient and prescription drug costs but lower emergency care costs than VA patients.ConclusionPatients receiving community primary care had worse diabetes quality and higher costs than patients receiving VA primary care. There was no difference in health outcomes. Care provided by an integrated delivery system may have advantages in quality and value.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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