Who receives DXA in VHA direct care vs. community care? Insights into bone health care for veterans.

UNLABELLED: Veterans who choose to receive bone densitometry from a community clinic had less travel burden but may have experienced a longer time from referral to DXA. Ensuring access to DXA for accurate, timely diagnosis and to guide osteoporosis screening remains an important priority.

PURPOSE: The Veterans Access, Choice, and Accountability Act (2014) expanded access to community-based dual-energy X-ray absorptiometry (DXA) for eligible veterans facing substantial travel burden or delays in VA access. We examined differences in travel burden, time from referral to DXA, and sociodemographic factors associated with receipt of VA-based DXA (VA-DXA) versus community DXA (CC-DXA) to understand the impact of this policy on veteran access to care.

METHODS

We used mixed-effects logistic regression to estimate odds of receiving VA-DXA versus CC-DXA, from October 1, 2019-July 1, 2023, adjusting for clinical and demographic factors related to osteoporosis and access barriers.

RESULTS

For veterans living < 40 miles from a VA DXA site, CC-DXA recipients traveled shorter distances than VA-DXA recipients (median 6.6 vs. 13.8 miles); this difference widened for those > 40 miles away from a VHA facility (7.0 vs. 60.7 miles). Conversely, VA-DXA had shorter elapsed time from referral to DXA regardless of proximity (e.g., < 40 miles: 24 vs. 39 days from referral). In adjusted models, living > 40 miles from a tertiary VA facility was the strongest predictor of CC-DXA (aOR 4.86). CC-DXA use was more likely among female (aOR 1.60) and rural veterans (aOR 2.01) and among those with low/moderate frailty, and less likely among Black (aOR 0.50) and Asian veterans (aOR 0.57) compared with White veterans, and among Hispanic versus non-Hispanic veterans (aOR 0.84).

CONCLUSIONS

CC-DXA reduced travel burden but was associated with longer referral-to-DXA time. Ongoing monitoring is warranted to ensure equitable, timely DXA access.