Running Head: Evaluation of Contract Versus VA-Staffed CBOCs. Evaluating Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCs) Using Patient Satisfaction and Access Measures in the Veterans Health Administration

摘要

The Veterans Health Administration (VHA) is the largest public health system in the United States. As of June 2008, it provided care to Veterans through 153 medical centers and 737 community-based outpatient clinics (CBOCs). This research investigates differences in contract versus VA-staffed CBOCs in terms of patient satisfaction, clinic wait times within 30 days for appointments, and missed clinic opportunity rates. Contract versus VA-staffing of a CBOC serves as the grouping variable in Student's/tests for differences in mean scores, as well as the dependent variable in logistic regression models considering independent variables of scores and clinic and patient characteristics. Student's / tests for differences in mean scores indicate that contract CBOCs have higher patient satisfaction for clinic access than VA- staffed CBOCs, but lower satisfaction scores for continuity of care. Logistic regression models find patient satisfaction scores for access to be a positive predictor of a CBOCs contract status, but patient perceptions of coordination of care are a negative predictor of a CBOCs contract status. Similar analysis using / tests and logistic regression finds that contract CBOCs do better in providing access to appointments within 30 days. However, contract CBOCs had more missed clinic opportunities.