Evaluation of the Department of Veterans Affairs community-based outpatient clinics.
OBJECTIVE
This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications of the CBOC Performance Evaluation Project.


METHODS
There were 139 CBOCs in operation at the end of fiscal year 1998. Ninety-eight percent of CBOCs offered primary health care, and 28% offered primary health care and primary mental health care. The average CBOC was 70.7 miles from its parent VAMC. Sixty-one percent of the CBOCs were located in urban areas and 39% were in rural areas. Sixty-four percent of the CBOCs were VA-staff and 36% were contract.


RESULTS
The details of the project's findings are reported in four companion papers that describe, respectively, health care access and utilization, cost of care, patient perceptions of care, and quality of care in VA CBOCs. For most measures, CBOC performance was equivalent to their parent VAMCs. However, there were a few areas of potential concern: CBOCs had fewer patients that reported having one provider or team in charge of care; CBOC patients had fewer specialty visits; and CBOCs served a smaller percent of women and black persons.


CONCLUSIONS
CBOCs appear to be performing comparably to their parent medical centers but will benefit from ongoing monitoring.
Chapko
Michael K
MK
Health Services Research and Development, Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, Washington 98108, USA. chapko@u.wahington.edu
Borowsky
Steven J
SJ
Fortney
John C
JC
Hedeen
Ashley N
AN
Hoegle
Marsha
M
Maciejewski
Matthew L
ML
VanDeusen Lukas
Carol
C
D003151:Community Health Centers / Q000592:standards*; D003156:Community Mental Health Services / Q000592:standards; D003365:Costs and Cost Analysis; D006297:Health Services Accessibility / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D017060:Patient Satisfaction; D011787:Quality of Health Care / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs; D014600:Utilization Review