Journal of general internal medicine
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The Maintaining Internal Systems and Integrated Outside Networks (MISSION) Act of 2018 was created in response to reports of prolonged wait times for veterans accessing health care within the Veterans Affairs (VA) system. In Michigan, the MISSION Act Community Care Program led to an increased number of veterans receiving specialty care outside the VA system, in part due to the complicated process of coordinating specialty care within the VA system. From 2018 to 2020, the percentage of veterans referred to the VA Ann Arbor Healthcare System (AA) for specialty care from its two referring facilities, Battle Creek VA Medical Center (BC) and Saginaw VA Healthcare System (SAG), decreased from 54.4 to 27%. ⋯ This multifacility effort is an example of a highly coordinated, veteran-centered collaboration that has led to successful retention of veterans within the VA system with resultant large-scale cost avoidance and comparable clinic wait times. Focusing on central care coordination and veteran engagement in the referral process are keys to its success, along with leveraging existing referral patterns between nearby VA facilities. This model could be extrapolated to other VA markets throughout the country where similar relationships exist.
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High-sensitivity cardiac troponin (hs-cTn) is now the recommended biomarker for diagnosis of non-ST-elevation myocardial infarction, but proper interpretation varies based on the assay being used. Nearly uniformly, suggested interpretations of assay-specific hs-cTn results are based on predictive values, which are not applicable to most patients. ⋯ Furthermore, we will provide a blueprint for how to use existing published data presented with predictive values to calculate likelihood ratios. Changing the output of diagnostic accuracy studies and diagnostic algorithms from predictive values to likelihood ratios can improve patient care.