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Objective: To examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. Data Sources and Study Setting: VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. Study Design: Retrospective cohort study to compare 7‐ and 30‐day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA‐funded stay in community facility [CC], or Medicare‐funded community stay [CMS]). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. Data Collection/Extraction Methods: Veterans with active VA primary care utilization and ≥1 acute hospitalization between January 1, 2016 and December 31, 2021. Principal Findings: Monthly index stays increased for all payors until MISSION Act implementation, when VHA and CMS admissions declined while CC admissions accelerated and overtook VHA admissions. In December 2021, CC admissions accounted for 54% of index admissions, up from 25% in January 2016. From adjusted models, just prior to implementation (May 2019), Veterans with CC admissions had 47% greater risk of 7‐day readmission (risk ratio [RR]: 1.47, 95% confidence interval [CI]: 1.43, 1.51) and 20% greater risk of 30‐day readmission (RR: 1.20, 95% CI: 1.19, 1.22) compared with those with VHA admissions; both effects persisted post‐implementation. Pre‐implementation CC admissions were also associated with higher 7‐ and 30‐day ED visits, but both risks were substantially lower by study termination (RR: 0.90, 95% CI: 0.88, 0.91) and (RR: 0.89, 95% CI: 0.87, 0.90), respectively. Conclusions: MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post‐implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post‐implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation. [ABSTRACT FROM AUTHOR]

The article presents a commentary on how the Veterans Administration (VA) healthcare system is leveraging telehealth to provide continued access to care for rural veterans. Topics include disruptions in transportation and other non-medical services, and widespread isolation due to recommended social distancing guidelines; and impact access to care and outcomes for individuals with chronic medical and mental health disorders.

Research Objective: Veterans with opioid use disorder (OUD) are at significant risk of overdose, unintentional death, and a wide range of negative health‐related consequences. While evidenced‐based treatments for OUD exist, including medications for opioid use disorder (MOUD) like buprenorphine (suboxone), there are a number of barriers preventing veterans from accessing this care. A potential avenue to increase the numbers of veterans who can access high quality mental healthcare such as MOUD is through telemental healthcare using VA Video Connect (VVC). While telehealth can mitigate this access to care issue, the opioid crisis led to the Ryan Haight Act of 2008, which mandates that the first visit with a prescriber of schedule II‐IV controlled substances be conducted in person. However, due to the public health emergency caused by COVID‐19, the in person requirement for controlled substances is temporarily waived. Study Design: The aims of this project were to examine temporal changes in controlled substances from September 2019 – August 2020 (6 months before and after the requirement was waived), to understand the impacts of this waiver for veterans with OUD. Population Studied: We examined prescription information from the VA Corporate Data Warehouse for 42,579 Veterans diagnosed with OUD (91.6% male, 71% white, 16.8% black, 27% rural dwelling). Principal Findings: During this 12‐month window, 56.6% of the sample were prescribed suboxone, 53.6% were prescribed sedatives, and 13.8% were prescribed anxiolytics. Monthly an average of 33,323 (SD = 3190) prescriptions were filled, with an average of 1.45 (SD = 0.08) medications prescribed per visit. As expected, the largest dip was seen in April 2020, with only 28,376 prescriptions filled, with an 1.33 prescriptions written per visit. As of August 2020, the rates for prescriptions for controlled substances had not returned to pre‐COVID levels. Conclusions: These data suggest that while telehealth is a legal option to appropriately prescribe controlled substances, it was not utilized in a way that replicated in person care. Future projects that focus on understanding and addressing barriers providers face when attempting to provide care via telehealth are an important next step. Additionally, there was no dramatic increase in prescriptions for controlled substances as a result of the Ryan Haight waiver. Implications for Policy or Practice: These data support keeping the wavier of in person appointments in the Ryan Haight Act is one useful avenue to help providers to provide access to life saving MOUDs. Primary Funding Source: Department of Veterans Affairs. [ABSTRACT FROM AUTHOR]

J Clin Hypertens (Greenwich) Treatment of hypertension among hospitalized patients represents an opportunity to improve blood pressure recognition and treatment. To address this issue, the authors examined patterns of antihypertensive medication prescribing among 5668 hypertensive inpatients. Outcomes were treatment with any antihypertensive medication and treatment with first-line therapy, defined as angiotensin-converting enzyme inhibitors, β-blockers, thiazide diuretics, or calcium channel blockers. Logistic regression models adjusting for age, sex, race, length of stay, service line, and comorbidity were used for all comparisons. The multivariate-adjusted odds ratios for treatment were higher for men (1.4, P<.001), older patients (2.5 for age older than 80 vs 1.0 for age younger than 40; P<.001), non-white race (1.2 vs 1.0 for white race; P<.004), and generalist service line (1.4 vs 1.0 for all other services; P<.001). Multivariate-adjusted odds ratios for receiving first-line agents were higher for older patients and generalist service line. Among surgical patients, receipt of medical consultation was only marginally associated with higher odds of antihypertensive or first-line treatment after adjustment for relevant clinical variables. Demographic factors and service line appear to play a major role in determining the likelihood of inpatient hypertension treatment. Understanding and addressing these disparities has the potential to incrementally improve hypertension control rates in the population. [ABSTRACT FROM AUTHOR]