Abstract：
The Veterans Health Administration (VA) increasingly purchases community-based care (CC) to improve healthcare access, including behavioral health. In 2018, VA introduced standardized episodes of care (SEOCs) to guide authorization and purchase of CC services for specific indications in a defined timeframe without bundling payment. In this retrospective cross-sectional study, we describe trends in VA and CC behavioral healthcare utilization using the VA Outpatient Psychiatry SEOC definition. Counts of Outpatient Psychiatry SEOC-allowable service and procedure codes during fiscal years 2016-2019 were organized according to four SEOC-defined service types (evaluation and management, laboratory services, psychiatry services, transitional care) and measured as percentages of all included codes. Trends comparing behavioral healthcare utilization between Veterans using any CC versus VA only were analyzed using a linear mixed effects model. We identified nearly 3 million Veterans who registered 60 million qualifying service and procedure codes, with overall utilization increasing 77.8% in CC versus 5.2% in VA. Veterans receiving any CC comprised 3.9% of the cohort and 4.7% of all utilization. When examining service type as a percent of all Outpatient Psychiatry SEOC-allowable care among Veterans using CC, psychiatry services increased 12.2%, while transitional care decreased 8.8%. In regression analysis, shifts in service type utilization reflected descriptive results but with attenuated effect sizes. In sum, Outpatient Psychiatry SEOC-allowable service utilization grew, and service type composition changed, significantly more in CC than in VA. The role of SEOCs and their incentives may be important when evaluating future behavioral healthcare quality and value in bundled services.
摘要：
退伍军人健康管理局（VA）越来越多地购买社区护理（CC），以改善医疗保健服务。包括行为健康。2018年，VA引入了标准化护理事件（SEOC），以指导在规定的时间范围内针对特定适应症授权和购买CC服务，而无需捆绑付款。在这项回顾性横断面研究中，我们使用VA门诊精神病学SEOC定义描述了VA和CC行为医疗利用的趋势.根据SEOC定义的四种服务类型（评估和管理，实验室服务,精神病学服务，过渡护理)，并以所有包含代码的百分比来衡量。使用线性混合效应模型分析了使用任何CC与仅使用VA的退伍军人之间的行为医疗保健利用的趋势。我们确定了近300万退伍军人，他们注册了6000万合格服务和程序代码，CC的总体利用率从VA的5.2%增加到77.8%。接受任何CC的退伍军人占队列的3.9%，占所有利用率的4.7%。在使用CC检查退伍军人中SEOC-允许的所有门诊精神病学护理的服务类型时，精神病学服务增长12.2%，而过渡期护理下降8.8%。在回归分析中，服务类型利用率的变化反映了描述性结果，但效果大小减弱。总之,门诊精神病学SEOC允许的服务利用率增长，服务类型组成发生了变化，CC明显高于VA。在评估未来的行为医疗质量和捆绑服务的价值时，SEOC及其激励措施的作用可能很重要。
