{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T11:11:16Z","timestamp":1790334676504,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The Veterans Affairs (VA) Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act expanded eligibility for community\u2010based care particularly for Veterans facing geographic or capacity\u2010related barriers. Patients with diabetic foot ulcers (DFU) require timely specialty management and are vulnerable to fragmented care, yet little is known about how the MISSION Act reshaped patterns of DFU\u2010related specialty care within and outside the VA. We conducted a retrospective cohort study of Veterans aged 65 or older with a new DFU diagnosis in VA between 2016 and 2022. We identified DFU\u2010related specialty encounters (podiatry, vascular surgery, infectious diseases and endocrinology) and categorised community encounters as VA\u2010paid or Medicare\u2010paid. We assessed annual trends in community specialty care and changes in the proportion and payer type of care before and after the MISSION Act. Among 76\u2009398 patients, VA\u2010paid community specialty care increased substantially following the MISSION Act, with larger relative growth among rural Veterans (rural: +119%; urban: +96%). In contrast, Medicare\u2010paid DFU specialty care declined during the same period (rural: \u221212%; urban: \u221213%). Following the MISSION Act, reliance on VA\u2010paid community specialty care increased markedly for Veterans with DFU, particularly in rural areas, while reliance on Medicare\u2010paid care decreased.<\/jats:p>","DOI":"10.1111\/iwj.71039","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:59:26Z","timestamp":1788933566000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changing Patterns of Specialty Care for Diabetic Foot Ulcers Among Rural and Urban Veterans Following the\u00a0\n                    <scp>VA\u00a0MISSION<\/scp>\n                    Act"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5953-3704","authenticated-orcid":false,"given":"Hiroyuki","family":"Suzuki","sequence":"first","affiliation":[{"name":"Veterans Rural Health Resource Center\u2010Iowa City VA Office of Rural Health  Iowa City Iowa USA"},{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8717-1061","authenticated-orcid":false,"given":"Mary","family":"Vaughan\u2010Sarrazin","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ohl","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1775-5453","authenticated-orcid":false,"given":"Bradley","family":"Mecham","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"McCoy","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-214X","authenticated-orcid":false,"given":"Daniel J.","family":"Livorsi","sequence":"additional","affiliation":[{"name":"Center for Access &amp; Delivery Research &amp; Evaluation Iowa City Veterans Affairs Health Care System  Iowa City Iowa USA"},{"name":"Department of Internal Medicine University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-2392"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.8120"},{"key":"e_1_2_11_4_1","unstructured":"\u201cVA MISSION Act of 2018 \u201d2018 H.R. 5674 115th Cong accessed May 11 20225 https:\/\/www.congress.gov\/115\/bills\/hr5674\/BILLS\u2010115hr5674rh.pdf."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13291"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.8399"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.15902"},{"key":"e_1_2_11_8_1","unstructured":"Trilogy Federal \u201cSurvey of Veteran Enrollees' Health and Use of Health Care \u201d2024 accessed April 10 2025 https:\/\/www.va.gov\/VHASTRATEGY\/SOE2024\/SOE24.pdf."},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.6781"},{"key":"e_1_2_11_10_1","unstructured":"U.S. Department of Veterans Affairs \u201cOffice of Rural Health. VHA and ORH Adopt New System to Define \u201cRural\u201d \u201daccessed May 11 2025 https:\/\/www.ruralhealth.va.gov\/ rural\u2010definition.asp."},{"key":"e_1_2_11_11_1","unstructured":"Agency for Toxic Substances and Disease Registry \u201cSocial Vulnerability Index: Overview \u201daccessed May 9 2024 https:\/\/www.atsdr.cdc.gov\/placeandhealth\/svi\/index.html."},{"key":"e_1_2_11_12_1","unstructured":"Veteran Community Care Eligibility Fact Sheet \u201cVA Office of Community Care \u201d2019."},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2019.08.244"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.4312"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.0827"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000028864"}],"container-title":["International Wound Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71039","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/iwj.71039","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/iwj.71039","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:54:57Z","timestamp":1790333697000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/iwj.71039"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":15,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/iwj.71039"],"URL":"https:\/\/doi.org\/10.1111\/iwj.71039","archive":["Portico"],"relation":{},"ISSN":["1742-4801","1742-481X"],"issn-type":[{"value":"1742-4801","type":"print"},{"value":"1742-481X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71039"}}