Megan E Vanneman, Fatima G Rahim, Megan E Amuan, Richard E Nelson, Adam J Gordon, Audrey L Jones
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引用次数: 0
Abstract
Objective: To establish methods for comparing Department of Veterans Affairs (VA)-direct and VA-purchased "community care" (CC) for methadone medication for opioid use disorder (M-MOUD), and determine differences in access, quality, and cost.
Study setting and design: Three outcome measures were constructed: wait times (from clinician referral to appointment) for access, retention on M-MOUD (number of months, from one to six) for quality, and 6-month treatment costs (M-MOUD and related services). We used generalized linear models to estimate differences in each outcome for CC versus VA.
Data sources and analytic sample: VA electronic health record and CC claims. Our study included VA patients referred by clinicians for M-MOUD between April 1, 2023-March 31, 2024 in VA (n = 389) and CC (n = 219) and, secondarily, VA walk-ins (n = 1830).
Principal findings: Average unadjusted wait times from clinician referral to appointment were 15.73 days (standard deviation [SD] = 16.27) in VA and 19.03 days (SD = 19.12) in CC, while there was no wait time for Veterans seen as VA walk-ins. Average unadjusted M-MOUD retention was 2.07 months (SD = 1.65) in VA and 3.13 months (SD = 1.84) in CC. Average unadjusted 6-month costs were $7360 (SD = $9554) in VA and $4376 (SD = $2171) in CC. In adjusted models, CC had greater M-MOUD retention (1.07 months longer, p < 0.0001) and lower costs ($-1720, p < 0.05) compared to VA clinician referral; wait times did not statistically differ (p = 0.12). M-MOUD retention and cost patterns did not change when considering VA walk-ins.
Conclusions: An important option for expanding Veterans' access to M-MOUD is through CC. In this group of Veterans receiving M-MOUD, CC retention was greater and costs were lower. However, CC lacks the walk-in option for same-day access. This signals tradeoffs to consider when assessing the balance between VA and CC and provides methods for comparing VA and CC treatment options.
期刊介绍：
Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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