# Leveraging a natural experiment to identify the effects of VA community care programs on health care quality, equity, and Veteran experiences

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: The Veterans Choice Program and MISSION Act have transformed how VA delivers care by
expanding Veterans’ eligibility to receive VA-funded care from community providers. The effects of this change
on the quality and equity of care are unknown. Understanding these effects is critical, given the importance of
these programs to VA and the complexity of managing care for Veterans across different health systems. To
address this evidence gap, we will use a quasi-experimental regression discontinuity (RD) design and examine
outcomes in medically and socially vulnerable subgroups to determine the impact of Choice and MISSION on
quality and equity of Veterans’ health care. To further examine impacts on vulnerable groups, we will analyze
disparities in ratings of community care from VA’s Survey of Healthcare Experiences of Patients (SHEP).
Significance: This proposal addresses cross-cutting HSR&D research priorities, including evaluating the
quality and equity of care for Veterans in the context of a key legislative priority for VA: the MISSION Act. We
will examine how the effects of receiving community care, and patient experiences with community care, differ
in vulnerable populations, addressing VA priorities related to equity. The project constitutes an advancement in
the rigor of research while directly informing ongoing and high priority clinical initiatives within VA.
Innovation and Impact: Our project is innovative because it uses an RD design to provide causal evidence
about the effects of community care on the quality and equity of outpatient care and prescribing. The project is
also innovative and impactful in its attention to subpopulations of socially and medically vulnerable Veterans,
including analyses of disparities in community care patient experiences from national survey data. By working
closely with operational partners and a Veterans Advisory Board, we will impact VA policy by translating
findings into actionable recommendations to improve community care, particularly for vulnerable groups.
Specific Aims: (1) Identify the effects of receiving outpatient community care through Choice and MISSION on
quality and equity. (2) Identify the effects of community care on the quality and equity of prescribing. (3)
Compare Veterans’ experiences with community care in vulnerable and other Veteran populations.
Methodology: We will use an RD design and analyses of both administrative and VA survey data to assess
the effects of Choice (all program years) and MISSION (2019-2022) on the quality and equity of Veterans’
health care. Aims 1-2 will use a quasi-experimental RD design that compares Veterans just above vs. below
distance and travel time eligibility thresholds for VA community care in Choice and MISSION. We will study
effects of community care use on quality overall and, to evaluate implications for equity, in vulnerable
subpopulations defined by the presence of serious mental illness or substance use disorders, complex chronic
cond...

## Key facts

- **NIH application ID:** 10844366
- **Project number:** 5I01HX003457-03
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Walid F. Gellad
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-04-01 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10844366

## Citation

> US National Institutes of Health, RePORTER application 10844366, Leveraging a natural experiment to identify the effects of VA community care programs on health care quality, equity, and Veteran experiences (5I01HX003457-03). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10844366. Licensed CC0.

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