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Publication Briefs

Better Patient Experience for Outpatient Care Delivered by VA vs Community Care on Every Measure but Access

Timely access to outpatient care was a primary driver behind VA’s increased purchase of community-care (CC) under the Choice Act (2014). To date, no VA to CC comparisons have examined trends in patient experiences over time or later during the implementation of Choice, when stronger relationships between VA and CC had been built. Thus, this study examined trends in Veterans’ experiences with outpatient CC compared with those in VA during the second and third years after Choice implementation. Using data from VA’s Survey of Healthcare Experiences of Patients (SHEP) from VA’s Office of Reporting, Analytics, Performance, Improvement & Deployment (RAPID), investigators compared Veterans’ scores on four dimensions of experience—access, communication, coordination, and provider rating—for outpatient specialty, primary, and mental healthcare received from quarter two in 2016 through quarter four in 2017. Investigators also adjusted for covariates such as sociodemo-graphics, rurality, VA enrollment priority, as well as perceived physical and mental health status.


  • Patient experiences were better for VA than community care in all respects except For specialty care, access scores were better in the community; and for primary and mental healthcare, access scores were similar in the two settings.
  • There were significant differences in sociodemographic characteristics between VA and CC respondents across all types of outpatient care. Overall, VA respondents were older; had better perceived physical health status and mental health; had different distributions by race and ethnicity (i.e., higher portion of African American respondents); had lower education levels; lived in more urban areas; and were more likely to be insured.


  • As purchased care further expands under the MISSION Act, the monitoring of meaningful differences between healthcare settings should continue, with the results used to inform both VA purchasing decisions and patients' care choices.


  • Specialty care categories were combined rather than keeping them separate (i.e., cardiology, orthopedics), even though Veterans' experiences with specialty care may vary across categories.

This study was partly funded by an HSR&D grant (SDR 18-318). Dr. Vanneman is funded by an HSR&D Career Development Award (CDA 15-259), and Dr. Wagner is funded by an HSR&D Research Career Scientist award (RCS 17-154). Dr. Rosen is funded by an HSR&D Senior Research Career Scientist award (RCS 97-401). Dr. Vanneman is part of HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center; Dr. Wagner directs HSR&D’s Health Economics Resource Center and is Assistant Director of HSR&D’s Center for Innovation to Implementation; Drs. Shwartz and Rosen are part of HSR&D’s Center for Healthcare Organization and Implementation Research; Dr. Meterko is a survey methodologist for VA’s RAPID; Dr. Francis is VA’s Chief Improvement & Analytics Officer for RAPID; and Dr. Greenstone is VA’s Deputy Executive Director for Clinical Integration, Office of Community Care

Vanneman ME, Wagner TH, Shwartz M, Meterko M, Francis J, Greenstone CL, and Rosen AK. Veterans’ Experiences with Outpatient Care: Comparing the Veterans Affairs System with Community-Based Care. Health Affairs. August 2020;39(8):1368-1376.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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