{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T04:32:56Z","timestamp":1792989176547,"version":"4.5.0"},"reference-count":35,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007181","name":"Quality Enhancement Research Initiative","doi-asserted-by":"publisher","award":["PEC 16\u2010001"],"award-info":[{"award-number":["PEC 16\u2010001"]}],"id":[{"id":"10.13039\/100007181","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the impact of Veterans' urgent care use in non\u2010Veterans Health Administration (VHA) clinics on their later use of specialty and emergency care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>A retrospective cohort study analyzing urgent care, specialty care, and emergency department (ED) visits using VHA administrative and claims data. Veterans' first urgent care visit was the index visit, and subsequent utilization was tracked for up to 1\u2009year. We used an instrumental variable (IV) approach to estimate the effect of non\u2010VHA urgent care visits on the proportion of subsequent visits in non\u2010VHA clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used VHA administrative and community care claims data (2021\u20132022) obtained from the Corporate Data Warehouse. Our sample comprised VHA enrollees with at least one urgent care visit at a VHA or non\u2010VHA urgent care clinic in 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Of the 111,898 Veterans in the sample, 90,651 (81%) had their urgent care visit in the VHA, while 21,247 (19%) visited a non\u2010VHA clinic. IV models showed that Veterans using non\u2010VHA urgent care had 40 percentage points higher proportions of non\u2010VHA specialty care within 30\u2009days compared to those using VHA (95% CI: 37, 43). Effects stabilized at 28 percentage points within 365\u2009days post urgent care visit (95% CI: 26, 30). In contrast, the effect of community urgent care on subsequent ED use outside the VHA system after 30\u2009days of urgent care use was negligible and statistically insignificant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Veterans' use of non\u2010VHA urgent care can lead to increased subsequent use of non\u2010VHA specialty care but has no effect on non\u2010VHA emergency care utilization within 60 to 365\u2009days after urgent care visit. While expanded community care improves access in the short run, it also introduces care coordination challenges throughout an episode of care that may negatively affect health outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70162","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:25:35Z","timestamp":1788344735000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Veterans' Urgent Care Use and Subsequent Utilization in the Community"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3223-607X","authenticated-orcid":false,"given":"Farai M.","family":"Kuwonza","sequence":"first","affiliation":[{"name":"Partnered Evidence\u2010Based Policy Resource Center VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Health Law, Policy &amp; Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7425-9873","authenticated-orcid":false,"given":"Sivagaminathan","family":"Palani","sequence":"additional","affiliation":[{"name":"Partnered Evidence\u2010Based Policy Resource Center VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Health Law, Policy &amp; Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Smith","sequence":"additional","affiliation":[{"name":"Partnered Evidence\u2010Based Policy Resource Center VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Health Law, Policy &amp; Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-5976","authenticated-orcid":false,"given":"Steven D.","family":"Pizer","sequence":"additional","affiliation":[{"name":"Partnered Evidence\u2010Based Policy Resource Center VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Department of Health Law, Policy &amp; Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Department of Veterans Affairs \u201cVeterans Health Administration \u201daccessed August 13 2024 https:\/\/www.va.gov\/health\/."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001549"},{"key":"e_1_2_11_4_1","unstructured":"J.Sen Isakson \u201c[R\u2010GA]. Text \u2010 S.2372 \u2010 115th Congress (2017\u20132018): VA Mission Act of 2018 \u201daccessed February 2 2024 https:\/\/www.congress.gov\/bill\/115th\u2010congress\/senate\u2010bill\/2372\/text."},{"key":"e_1_2_11_5_1","unstructured":"Department of Veterans Affairs \u201cVA Mission Act: VA's New Urgent Care Benefit for Veterans \u2010 VA News \u201daccessed August 13 2024 https:\/\/news.va.gov\/60896\/va\u2010mission\u2010act\u2010vas\u2010new\u2010urgent\u2010care\u2010benefit\u2010for\u2010veterans\/."},{"key":"e_1_2_11_6_1","unstructured":"Department of Veterans Affairs \u201cGetting Urgent Care at VA or In\u2010Network Community Providers \u201dVeterans Affairs accessed August 13 2024 https:\/\/www.va.gov\/resources\/getting\u2010urgent\u2010care\u2010at\u2010va\u2010or\u2010in\u2010network\u2010community\u2010providers\/."},{"key":"e_1_2_11_7_1","unstructured":"U.S. Department of Veterans Affairs \u201cVeteran Care Overview \u201daccessed August 13 2024 https:\/\/www.va.gov\/COMMUNITYCARE\/programs\/veterans\/index.asp."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010024\u201008787\u20107"},{"key":"e_1_2_11_9_1","volume-title":"Urgent Care Industry White Paper: The Essential Nature of Urgent Care in the Healthcare Ecosystem Post\u2010COVID\u201019","author":"Urgent Care Association","year":"2023"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01869"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13631"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3386\/w25428"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2016.03.013"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2023.102753"},{"key":"e_1_2_11_15_1","unstructured":"\u201cHospitals Acquire Urgent Care Centers: A Win\u2010Win \u201dExperity accessed August 13 2024 https:\/\/www.experityhealth.com\/blog\/hospitals\u2010acquire\u2010urgent\u2010cares\/."},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14667"},{"key":"e_1_2_11_17_1","unstructured":"Centers for Medicare & Medicaid Services \u201cPlace of Service Code Set \u201daccessed July 18 2024 https:\/\/www.cms.gov\/medicare\/coding\u2010billing\/place\u2010of\u2010service\u2010codes\/code\u2010sets."},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/23814683211057902"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.43062"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13033"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1198\/07350010152472571"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12355"},{"key":"e_1_2_11_23_1","volume-title":"VHA Directive 1101.13(1): VHA Urgent Care","author":"Veterans Health Administration","year":"2023"},{"key":"e_1_2_11_24_1","volume-title":"VHA Directive 1101.14(1): Emergency Medicine","author":"Veterans Health Administration","year":"2023"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511614491.006"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jth.2024.101819"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.20f13681"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13051"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1257\/aer.20211638"},{"key":"e_1_2_11_30_1","article-title":"Inbound Referral Strategies for Urgent Care","author":"Ayers A. 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