13 Evaluating the effects of care coordination during the VA MISSION Act Era

Oregon Convention Center 

Background: Care coordination (CC) for Veterans with inpatient admissions in the community is an important element of the MISSION Act of 2018, considered vital for reducing poor outcomes due to fragmented care. Few studies have evaluated early impacts of CC. Methods: We compared several ways to extract CC activity from the VA Corporate Data Warehouse and created a matched cohort using propensity scores for the probability of receiving CC. We used generalized linear models with GEE to account for clustered data to estimate the risks for 30-day readmission, 30-day ED visits, 90-day and 1-year mortality. We also developed facility level models by aggregating patient-level data and accounted for facility complexity and percentage of community admissions involving CC. Results: Patient-level models estimated CC was associated with higher risk for each outcome; for example, those assigned 'complex' coordination had 28% greater risk for 30-day readmission (RR:1.28,95%CI:1.26, 1.3) and 21% greater risk of 90-day mortality (RR:1.21,95%CI:1.17, 1.3). Facility level models indicated increased CC activity was not associated with a significant risk change for any outcome.

VA care coordination

MISSION Act

Healthcare outcomes research

Effectiveness research 

Biometrics Section