Use and Quality of Care at a VA Outreach Clinic in Northern Maine

OBJECTIVE: To assess use and quality of care at a new 1-day-per-week Veterans Administration Outreach Clinic in remote northern Maine. METHODS: Veterans Administration electronic medical records were abstracted to compare outreach clinic patients seen in its first year to patients seen at the nearest outpatient treatment sites, a small-staff, full-time VA clinic 81 miles away and a community-based outpatient clinic 55 miles away. Chart abstractions (N = 1251) yielded counts of visits, patients newly enrolled in VA care, patients transferring to the outreach clinic, and patients who had and maintained a local non-VA primary care physician, as well as multiple quality of care performance measures using standard VA criteria. RESULTS: The outreach clinic enrolled very few patients new to VA; 96% of its patients were transfers from other sites. For transfers, the average one-way driving burden to reach primary care was reduced by 52.9 miles and 58.1 minutes to reach. Compared to community-based outpatient clinic patients, outreach clinic patients were more likely to have three or more provider visits during the year. Some quality of care measures were lower at the outreach clinic: obesity screenings, referrals to smoking cessation services, diabetes management, and hypertension control. At all three sites, most patients had health insurance coverage and kept a local, non-VA doctor throughout the year. CONCLUSIONS: A part-time outreach clinic improved the convenience of primary care for rural VA outpatients, though quality of care was reduced for some measures related to equipment and staffing limitations. Most patients at any VA site had a local, non-VA medical doctor with whom they remained in care while using VA services.