Quality of Mitral Valve Surgery at the United States Department of Veterans Affairs
Summary: Reports questioning the quality and access to care at the US Department of Veterans Affairs (VA) have been constantly featured in the national press.1 In this issue of the Journal, Bakaeen and colleagues2 provide a comprehensive report on the status of mitral valve surgery at the VA during a 14-year period. This report, coauthored by some of the most experienced and skillful mitral valve surgeons in the country, supports the notion that veterans receive quality mitral valve surgery at the VA facilities.
Abstract: IMPORTANCE: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated. OBJECTIVE: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics. SETTING: VHA outpatient setting. PARTICIPANTS: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived