Community Based Outpatient Clinics (CBOC) represent one of VA's main managed care strategies for shifting the focus of care from the inpatient to the outpatient setting and for improving the health of our nation's veterans. Hypothesis-driven research is critically needed to test the basic assumptions motivating the expansion of CBOCs throughout the VA health care system. The specific aims are 1) To evaluate the impact of CBOCs on the service use patterns and costs of patients with ambulatory care sensitive conditions. We will test the hypotheses that after opening a CBOC, current users in its catchment area with ambulatory care sensitive conditions will have greater utilization of primary care outpatient services and lower utilization of inpatient and specialty outpatient services. In addition, we will test the hypothesis that after the opening of an Access Point, current users in its catchment area with ambulatory care sensitive conditions will have lower overall treatment costs. 2) To estimate the workload and cost of providing health care to old and new users in CBOC catchment areas. The overall rate of service use and the rate of new users will be compared for zip codes inside and outside CBOC catchment areas. Descriptive statistics for the demographic and clinical characteristics of new users will also be measured and compared to new users. The utilization and costs of current users, new users and all users will be determined and compared between patients inside and outside CBOC catchment areas. In addition, the utilization of patients from CBOC catchment areas will be categorized by location (CBOC or Parent facility) to determine how CBOCs affect the workload at the Parent facility. Study Design - A quasi-experimental pre-post study design with intervention and reference groups will be employed to compare service utilization and costs in the two years before and the two years after the opening of the CBOC. Sample Selection - Eleven CBOCs from six VISNs that were opened in the second half of FY97 will be included in the sample. Two samples for each CBOCs will be compiled. The first sample will include all current users in the CBOCs' catchment areas who were diagnosed with hypertension, diabetes, chronic obstructive pulmonary disease, angina, depression or alcohol dependence along with a reference group of current users outside CBOC catchment areas. The second sample will comprise all veterans in zip codes within the CBOCs' catchment areas and a reference group of veterans from zip codes outside CBOC catchment areas. Data Collection - The secondary data source is the VA's PTF and Census files housed at the Austin Automation Center. Data Analysis - Individual veteran and zip codes are defined as the units of analysis. Reference groups will be category-matched on the intervention group to ensure a similar distribution of key variables. The hypotheses will be tested using multivariate logistic and linear regression analyses. The dependent variables will be defined as post-CBOC inpatient utilization, outpatient utilization or cost. The explanatory variable of interest is whether the veteran resided inside a CBOC catchment area.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria