Center for Medical Ethics and Health Policy Staff Publications
Language
English
Publication Date
2-1-2024
Journal
Health Services Research
DOI
10.1111/1475-6773.14239
PMID
37750017
PMCID
PMC10771900
PubMedCentral® Posted Date
9-26-2023
PubMedCentral® Full Text Version
Post-print
Abstract
Objective: To measure key characteristics of the Veterans Health Administration's (VHA) Community Care (CC) referral network for screening colonoscopy and identify market and institutional factors associated with network size.
Data sources: VHA electronic health records, CC claim data, and National Plan and Provider Enumeration System.
Study design: In this retrospective cross-sectional study, we measure the size of the VHA's CC referral networks over time and by VHA parent facility (n = 137). We used a multivariable linear regression to identify factors associated with network size at the market-year level. Network size was measured as the number of physicians who performed at least one VHA-purchased screening colonoscopy per 1000 enrollees at baseline.
Data extraction: Data were extracted for all Veterans (n = 102,119) who underwent a screening colonoscopy purchased by the VHA from a non-VHA physician from 2018 to 2021.
Principal findings: From 2018 to 2021, median network volume of screening colonoscopies per 1000 enrollees grew from 1.6 (IQR: 0.6, 4.6) to 3.6 (IQR: 1.6, 6.6). The median network size grew from 0.63 (IQR: 0.30, 1.26) to 0.92 (IQR: 0.57, 1.63). Finally, the median procedures per physician increased from 2.5 (IQR: 1.6, 4.2) to 3.2 (IQR: 2.4, 4.7). After adjusting for baseline market characteristics, volume of screening colonoscopies was positively related to network size (β = 0.15, 95% CI: [0.10, 0.20]), negatively related to procedures per physician (β = -0.12, 95% CI: [-0.18, -0.05]), and positively associated with the percent of rural enrollees (β = 0.01, 95% CI: [0.00, 0.01]).
Conclusions: VHA facilities with a higher volume of VHA-purchased screening colonoscopies and more rural enrollees had more non-VHA physicians providing care. Geographic variation in referral networks may also explain differences in the effects of the MISSION Act on access to care and patient outcomes.
Keywords
geographic factors/spatial factors/small area variations, healthcare organizations and systems, health promotion/prevention/screening, referrals and referral networks, VA healthcare system
Published Open-Access
yes
Recommended Citation
Eck, Chase S; Ho, Vivian; Jiang, Cheng; et al., "Determinants of Referral Network Size for Screening Colonoscopies in the Veterans Health Administration After the Implementation of the MISSION Act" (2024). Center for Medical Ethics and Health Policy Staff Publications. 110.
https://digitalcommons.library.tmc.edu/med_ethics/110