Observational studyJournal of the American Medical Directors Association2025
Does the Veterans Health Administration Purchase High-Quality Home Health Care?
Observational study in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
9 authors.
Funding
Abstract
objectivesVeterans are frequently referred for skilled home health care (HHC) after hospital discharge. We examined access to high-quality VA-contracted home health agencies (HHAs) for Veterans following a VA medical center (VAMC) hospitalization and by rural or urban residence.
designRetrospective observational study. SETTING AND
participantsWe used national VA data from April 2015 to September 2019 and included all Veterans discharged from a VAMC hospitalization who received skilled HHC paid for by VA.
methodsWe assigned every eligible discharge a choice set of VA-contracted HHAs serving the Veteran's county and a choice set of all HHAs serving the Veteran's county. We calculated a quality ratio (QR): the percentage of high-quality VA-contracted (4- or 5-star) HHAs relative to all high-quality HHAs serving the county reported in Home Health Compare. We then aggregated the QR by VAMC. High QRs (average QR and 95% CI >1) indicate VA contracts with higher-quality HHAs, relative to all HHAs serving the county. Neutral QRs (positive or negative average QR and 95% CI includes 1) indicate no difference in quality. Low QRs (average QR and 95% CI <1) indicate a lower-quality network. We examined bootstrapped QRs by VAMCs, including the subset serving mostly rural Veterans.
resultsWe identified 60,406 VA-paid HHC episodes for 42,010 Veterans discharged from 113 VAMCs. Although 61.1% of VAMCs had high QRs, only 27.3% of the 33 VAMCs serving rural Veterans had high QRs. Rural-residing Veterans had lower proportions of high QRs than urban Veterans (46.3% vs 64.0%) and nearly double the proportion of neutral QRs (31.5% vs 16.2%), but similar proportions of low QRs (22.2% vs 19.1%). CONCLUSIONS AND IMPLICATIONS: Overall, VA-contracted HHAs were of higher quality compared to available HHAs serving Veterans' counties. Although VAMCs serving mostly rural Veterans provided less access to higher-quality HHAs, this effect was driven by more access to neutral quality HHAs in rural counties, not by differentially contracting with lower-quality HHAs.
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