Journal of general internal medicine
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The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. ⋯ Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.
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A great deal of research has focused on how hospitals influence readmission rates. While hospitals play a vital role in reducing readmissions, a significant portion of the work also falls to primary care practices. Despite this critical role of primary care, little empirical evidence has shown what primary care characteristics or activities are associated with reductions in hospital admissions. ⋯ Primary care practices that engaged in more readmission reduction activities had lower readmission rates. These findings add to the growing body of evidence suggesting that engaging in multiple activities, rather than any single activity, is associated with decreased readmissions.
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Driven by quality outcomes and economic incentives, predicting 30-day hospital readmissions remains important for healthcare systems. The Cleveland Clinic Health System (CCHS) implemented an internally validated readmission risk score in the electronic medical record (EMR). ⋯ The CCHS readmission risk score showed good performance across diverse hospitals, across diagnosis categories, between surgical/medical specialties, and by patient race and ethnicity categories for 3 years after implementation, including during COVID-19. Evaluating clinical decision-making tools post-implementation is crucial to determine their continued relevance, identify opportunities to improve performance, and guide their appropriate use.
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The Veterans Health Administration (VA) is the largest integrated health system in the US and provides access to comprehensive primary care. Women Veterans are the fastest growing segment of new VA users, yet little is known about the characteristics of those who routinely access VA primary care in general or by age group. ⋯ Women Veterans who routinely utilize VA primary care have significant multimorbid physical and mental health conditions and trauma histories. Meeting women Veterans' needs across the lifespan will require continued investment in woman-centered primary care, including integrated mental healthcare and emphasis on trauma-informed, age-specific care, guided by women's provider preferences.
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The unintended pregnancy rate in the US military is higher than among civilians. While 42% of unintended pregnancies end in abortion among civilian women, there are no data on the prevalence of abortion in the military overall or by service branch. ⋯ In this first study to report on abortion prevalence among US servicemembers, we found the proportion of unintended pregnancies resulting in abortion among a sample of US Navy members in 2016 was much lower than civilians, yet unintended pregnancy rates were higher.