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Early Impact of the Mission Act on Utilization of Veterans Affairs Transplant Centers

J. C. Walker1, C. Roumie2, I. D. Feurer3, R. Forbes4

1General Surgery, Vanderbilt University Medical Center (VUMC), Nashville, TN, 2Internal Medicine, VUMC, Nashville, TN, 3Surgery and Biostatistics, VUMC, Nashville, TN, 4VUMC, Nashville, TN

Meeting: 2022 American Transplant Congress

Abstract number: 1322

Keywords: N/A, Organ Selection/Allocation, Public policy, Resource utilization

Topic: Clinical Science » Public Policy » 21 - Non-Organ Specific: Public Policy & Allocation

Session Information

Session Name: Non-Organ Specific: Public Policy & Allocation

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: The Veterans Affairs (VA) Maintaining Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 was implemented in 2019 to increase veteran access to both VA and non-VA healthcare centers. Given limited VA transplant centers (VATCs), increased access to more geographically convenient non-VA transplant centers could have substantial effects on VATC utilization. We aimed to assess the impact of the MISSION Act on utilization of VATCs. All veterans require a referral to Transplant Referral and Cost Evaluation/Reimbursement (TRACER) system to be considered for transplant either at VATCs or to request community care funding for a transplant center external to the VA.

*Methods: Data from the VA TRACER system were used to perform descriptive analyses of candidate transplant referrals in the 14 months pre- (April 2018 – June 5, 2019) and post- (June 6, 2019 – September 2020) implementation of the MISSION Act. Utilization of VATC for transplant evaluation (evaluations performed at VATC / referrals received by VATC) was used in multivariable logistic regression models to evaluate effects of MISSION Act era and candidate characteristics on likelihood of utilization of VATC.

*Results: 4872 first/only transplant referrals were received during the study period (2351 pre-MISSION; 2521 post-MISSION). There were no statistically significant differences in candidate demographics (61.3 vs 61.1 years; 94.8% male vs 94.4% male; 59.2% white vs 62.1% white; 86.9% non-Hispanic vs 88.5% non-Hispanic; 55.3% married vs 55.8% married; all p>0.05) between eras, nor were there substantial differences in clinical eligibility (78.6% eligible vs 80;8% eligible; 96% stable vs 94.8% stable). More veterans were evaluated for transplant (5.7% vs 16%) and transferred outside of the VA (0.3% vs 9.4%) in the post-MISSION Act era. Of veterans expressing a preference, most intended to be listed at only a VATC (56.2%) rather than a community transplant center (12.7%) or both (31.1%). Multivariable logistic regression model of the utilization of VATC by MISSION Act era showed that, when adjusted for candidate characteristics, there was a decreased odds of utilization of VATC in the post-MISSION Act era (p<0.001) (Table 1).

*Conclusions: Utilization of VATCs has decreased in the post-MISSION Act era. Careful attention to patterns and preferences for veteran transplant candidates can inform future policy and funding decisions.

Adjusted multivariable logistic regression of likelihood of utilization of VATC and MISSION Act-era
Utilization OR 95% CI P-value
Post-MISSION 0.65 (0.57, 0.74) <0.001
Age 0.97 (0.97, 0.98) <0.001
Race (White) 1.02 (0.89, 1.17) 0.81
Gender (Male) 1.18 (0.87, 1.61) 0.27
Ethnicity (Hispanic) 1.20 (0.93, 1.56) 0.17
Marital status (Not married) 0.81 (0.71, 0.92) 0.002
Constant 16.0 (9.81, 26.0) <0.001
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To cite this abstract in AMA style:

Walker JC, Roumie C, Feurer ID, Forbes R. Early Impact of the Mission Act on Utilization of Veterans Affairs Transplant Centers [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/early-impact-of-the-mission-act-on-utilization-of-veterans-affairs-transplant-centers/. Accessed May 30, 2025.

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