ArticleJournal of general internal medicine2024
Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act.
Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed.
- Optimizing outpatient pharmacologic treatment for veterans with alcohol use disorder using an academic detailing approach for primary care providers in the United States Department of Veterans Affairs: A retrospective quasi-experimental study.Addiction (Abingdon, England) · 2026Article
- Timeliness of Colorectal Cancer Care in Veterans: The Role of Travel Distance.Cancer reports (Hoboken, N.J.) · 2026Article
- Incarceration History, Dental Care Utilization, and Oral Health Difficulties Among U.S. Military Veterans.Journal of public health dentistry · 2026Article
- Trends in Outpatient Specialty Care Referrals and Specialty Clinic Wait Times in the Veterans Affairs Health System Before and After VA Community Care Expansion.Journal of general internal medicine · 2026Article
- Perspectives of Rural and Urban Veterans with Military Sexual Trauma Seeking Psychotherapy Through Community Care: A Qualitative Study.The journal of behavioral health services & research · 2026Article
- Who receives DXA in VHA direct care vs. community care? Insights into bone health care for veterans.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Capacity for and Utilization of Dual-Energy X-Ray Absorptiometry Within the Veterans Health Administration.Journal of the American Geriatrics Society · 2026Article
- "Hit or Miss": Rural Veterans' Experiences Receiving Community Mental Health Care.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Post-Intensive Care Fragmentation Among Rural Veterans: Transitions Between VA and Community Health Systems.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- Characteristics of Rural Veterans Using VA Video-to-Home Telehealth or Community Care Network for Mental Healthcare.Psychiatric research and clinical practice · 2026Article
- Mental Health Leadership Perspectives on the Value of a National Virtual Contingency Staffing Program in the Veterans Health Administration.Administration and policy in mental health · 2026Article
- Suicide Prevention RCT Pilot: Rural Veterans Receiving Mental Health Community Care.Rural mental health · 2026Article
- Intensive Care Unit Admissions Purchased or Delivered by Veterans in the VA Health Care System.JAMA health forum · 2025Article
- Mental Health Treatment among U.S. Military Veterans: Insights from the National Health Interview Survey.Journal of general internal medicine · 2025Article
- Barriers and Facilitators to Cross-Institutional Referrals: System Configuration Analysis of VA Staff Experiences.Journal of general internal medicine · 2025Article
- Comparing Quality, Costs, and Outcomes of VA and Community Primary Care for Patients with Diabetes.Journal of general internal medicine · 2025Article
- After-hours, Severity, and Distance are Associated with Non-VHA Emergency Department Use for Older Veterans: Insights from a Regional Health Information Exchange.Journal of geriatric emergency medicine · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorized a major expansion of purchased care in the community for Veterans experiencing access barriers in the Veterans Affairs (VA) health care system.
objectiveTo estimate changes in primary care, mental health, and emergency/urgent care visits in the VA and community fiscal years (FY) 2018-2021 and differences between rural and urban clinics.
designA national, longitudinal study of VA clinics and outpatient utilization. Clinic-level analysis was conducted to estimate changes in number and proportion of clinic visits provided in the community associated with the MISSION Act adjusting for clinic characteristics and underlying time trends.
participantsIn total, 1050 VA clinics and 6.6 million Veterans assigned to primary care. MAIN MEASURES: Number of primary care, mental health, and emergency/urgent care visits provided in the VA and community and the proportion provided in the community. KEY
resultsNationally, community primary care visits increased by 107% (50,611 to 104,923), community mental health visits increased by 167% (100,701 to 268,976), and community emergency/urgent care visits increased by 129% (142,262 to 325,407) from the first quarter of 2018 to last quarter of 2021. In adjusted analysis, after MISSION Act implementation, there was an increase in community visits as a proportion of total clinic visits for emergency/urgent care and mental health but not primary care. Rural clinics had larger increases in the proportion of community visits for primary care and emergency/urgent care than urban clinics.
conclusionsAfter the MISSION Act, more outpatient care shifted to the community for emergency/urgent care and mental health care but not primary care. Community care utilization increased more in rural compared to urban clinics for primary care and emergency/urgent care. These findings highlight the challenges and importance of maintaining provider networks in rural areas to ensure access to care.
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