Population-level health intervention and primary care quality for Veterans

Abstract:Importance: The COVID-19 pandemic caused substantial disruptions to primary care, potentially impacting quality of care for chronic conditions. The Veterans Health Administration (VHA) implemented the Preventive Health Inventory (PHI) initiative, a multicomponent care management intervention, focused on chronic disease care and preventive screening to support the delivery of delayed care. Objective: To examine the association of PHI implementation with measures of primary care quality and potentially avoidable health care use. Design, Setting, and Participants: This cohort study used VHA administrative data of multiple propensity score–matched cohorts of veterans with diabetes and/or hypertension enrolled in primary care who received or did not receive care via the PHI. Data were collected from February 1, 2021, through February 28, 2022, and analyzed between April 30 and June 28, 2024. Exposure: Templated electronic health record note documenting use of the PHI. Main Outcomes and Measures: A difference-in-differences approach was used to evaluate the association of PHI receipt with diabetes and hypertension clinical quality measures (eg, poor diabetes control with a hemoglobin A1c >9% [75 mmol/mol]) and preventable use outcomes, including outpatient care use, preventable emergency department visits, and hospitalizations for ambulatory care–sensitive conditions. Results: For each outcome, separate cohorts of veterans who received the PHI intervention (from 8434 [statin therapy] to 97695 [preventable care use outcomes]) were propensity score matched with those who did not (from 5574 [statin therapy] to 118188 [preventable care use outcomes]). Veterans who received care using the PHI tool had a lower probability of poor diabetes control (2.9 percentage points [95% CI, −3.8 to −1.9 percentage points]) and a higher probability of adequate blood pressure control (4.0 percentage points [95% CI, 2.6-5.3 percentage points]). No differences were observed between groups for statin therapy or preventable use outcomes. Use of the PHI was associated with increased outpatient care use (310 [95% CI, 272-348] visits per 1000 veterans). Conclusions and Relevance This cohort study found that implementation of VHA’s PHI was associated with improved care quality of care for diabetes and hypertension and did not increase preventable care use, suggesting that the PHI may serve as a model for population health approaches that seek to reengage inactive patients since the COVID-19 pandemic.

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