TY - JOUR
AU - K. J. Nieser
AU - C. Chen
AU - A. H. S. Harris
AU - T. H. Wagner
AU - E. M. Schmidt
A1 - 
AB - BACKGROUND: The Veterans Health Administration (VHA) greatly expanded the proportion of health care services it purchases from community providers over the last decade, which could impact the quality of care and create care fragmentation. Continuity of care between inpatient and outpatient care delivery systems is critical for high-quality mental health care. OBJECTIVE: To compare rates of outpatient follow-up visits between VHA-purchased and VHA-delivered psychiatric hospitalizations, overall and by VHA facility. METHODS: Using VHA electronic medical records and community care claims data, we compared 7-day and 30-day outpatient follow-up rates across VHA-purchased and VHA-delivered settings. We estimated follow-up rates and comparisons overall as well as separately for 4 diagnosis groups and separately across VHA facilities. RESULTS: Our sample included 64,784 hospitalizations; more than 30% were VHA-purchased as opposed to VHA-delivered. Compared with VHA-delivered hospitalizations, follow-up rates were 30.1 (95% CI: 27.8-32.5) percentage points lower at 7 days and 22.5 (95% CI: 20.8-24.1) percentage points lower at 30 days for VHA-purchased hospitalizations. Lower follow-up rates occurred for neurocognitive disorder discharges for both VHA-purchased and delivered care. Follow-up rates at 30 days were significantly lower for VHA-purchased hospitalizations at 121 out of 128 facilities and significantly higher at no facility. CONCLUSIONS: VHA enrollees seeking mental health care and VHA program managers could benefit from data on psychiatric care quality differences between community providers and VHA providers. From a system perspective, VHA-purchased care quality reports and value-based purchasing contracts could include outpatient follow-up quality measures to incentivize higher quality care.
AD - Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA.; Department of Surgery, Stanford-Surgery Policy Improvement Research and Education Center, Stanford University, Stanford, CA.; Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA.; VHA Office of Performance Measurement, Analytics and Performance Integration, Quality and Patient Safety, Veterans Health Administration, Washington, D.C.
AN - 41359449
BT - Med Care
C5 - Financing & Sustainability; Healthcare Disparities
CP - 2
DA - Feb 1
DO - 10.1097/mlr.0000000000002271
DP - NLM
ET - 20251202
IS - 2
JF - Med Care
LA - eng
N2 - BACKGROUND: The Veterans Health Administration (VHA) greatly expanded the proportion of health care services it purchases from community providers over the last decade, which could impact the quality of care and create care fragmentation. Continuity of care between inpatient and outpatient care delivery systems is critical for high-quality mental health care. OBJECTIVE: To compare rates of outpatient follow-up visits between VHA-purchased and VHA-delivered psychiatric hospitalizations, overall and by VHA facility. METHODS: Using VHA electronic medical records and community care claims data, we compared 7-day and 30-day outpatient follow-up rates across VHA-purchased and VHA-delivered settings. We estimated follow-up rates and comparisons overall as well as separately for 4 diagnosis groups and separately across VHA facilities. RESULTS: Our sample included 64,784 hospitalizations; more than 30% were VHA-purchased as opposed to VHA-delivered. Compared with VHA-delivered hospitalizations, follow-up rates were 30.1 (95% CI: 27.8-32.5) percentage points lower at 7 days and 22.5 (95% CI: 20.8-24.1) percentage points lower at 30 days for VHA-purchased hospitalizations. Lower follow-up rates occurred for neurocognitive disorder discharges for both VHA-purchased and delivered care. Follow-up rates at 30 days were significantly lower for VHA-purchased hospitalizations at 121 out of 128 facilities and significantly higher at no facility. CONCLUSIONS: VHA enrollees seeking mental health care and VHA program managers could benefit from data on psychiatric care quality differences between community providers and VHA providers. From a system perspective, VHA-purchased care quality reports and value-based purchasing contracts could include outpatient follow-up quality measures to incentivize higher quality care.
PY - 2026
SN - 0025-7079
SP - 89
EP - 97+
ST - Purchasing Versus Providing Care at the VHA: Quality Differences in Follow-Up After Psychiatric Hospitalization
T1 - Purchasing Versus Providing Care at the VHA: Quality Differences in Follow-Up After Psychiatric Hospitalization
T2 - Med Care
TI - Purchasing Versus Providing Care at the VHA: Quality Differences in Follow-Up After Psychiatric Hospitalization
U1 - Financing & Sustainability; Healthcare Disparities
U3 - 10.1097/mlr.0000000000002271
VL - 64
VO - 0025-7079
Y1 - 2026
ER -