# NIH grant: A Prospective Cohort Study Evaluating the Quality of Community Care vs. VHA Care for Veterans with PTSD, Depression, and Anxiety (1I01RD000575-01A1) — retained record

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[original source ↗](https://reporter.nih.gov/project-details/1I01RD000575-01A1)

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NIH grant 1I01RD000575-01A1: A Prospective Cohort Study Evaluating the Quality of Community Care vs. VHA Care for Veterans with PTSD, Depression, and Anxiety
Institute: {'code': 'VA', 'abbreviation': 'VA', 'name': 'Veterans Affairs', 'admin_org_id': '12500964', 'admin_funding_url': ''}. PI: Derrecka M Boykin. Award: $.
Start: 2026-10-01T00:00:00.
Background: Dramatic rises in use and spending on community care have raised major concerns about
program sustainability and its impact on funding for direct care services in the Veterans Health Administration
(VHA). Community care referrals have been increasing at a rate of 15-20% each year with 40% of VHA
enrollees receiving a community referral in fiscal year (FY) 2023. In addition, community care costs exceeded
$30 billion in FY2024, a 19% increase from the prior year. Each year, community care expenses have
accounted for a larger percentage of the VHA total budget (from 12% in FY2014 to 25% in FY2024), which
inversely impacts funding for VHA direct care services. Community care is predicated on VHA’s commitment to
providing Veterans with the “soonest and best care.” However, inconsistent reporting and limited quality metrics
for community care have made it difficult to discern how well it meets this Agency Priority Goal. Significance
to VA: There is an urgent need for research on services that represent the largest categories of community
care spending, such as mental health care. Very few studies have conducted quality comparisons of mental
health care between community settings and VHA. The proposed study will use a prospective cohort design to
evaluate how well psychotherapy provided through community care addresses the needs of Veterans with
posttraumatic stress disorder (PTSD), depression, and anxiety compared to VHA for several reasons.
Evidence-based psychotherapies are the gold standard treatment for these highly prevalent mental health
conditions. Psychotherapy is qualitative distinct from other mental health services (e.g., medication
management, diagnostic assessments) in that it involves recurring appointments (either weekly or bi-weekly)
with the same provider across several months. Finally, there are concerns about whether the provision of
psychotherapy in the community is of similar quality to VHA. Given evidence that low quality and delayed care
increases Veterans risk for adverse health outcomes, functional impairment, and suicide, it is critical to ensure
that psychotherapy delivered through community care is a timely, effective, safe, and equitable alternative to
VHA. Innovation/Impact: Project innovations include: (1) quality comparison of psychotherapy through
community care relative to VHA – an understudied topic, (2) simultaneous evaluation of quality dimensions in a
single study – timeliness, effectiveness, patient-centeredness, safety, and equity; and (3) use of a prospective
cohort design to follow Veterans after they have been referred for treatment. Additionally, we will collect cost
estimates for psychotherapy through community care and VHA to understand the economic impacts of these
programs. This proposal has high potential to inform administrative and policy decisions related to community
care. Specific Aims: This study has 3 specific aims. Aim 1 will compare the psychotherapy quality between
community care and VHA based on measures of timeliness, effectiveness, patient-centeredness, safety, and
psychotherapy costs. Aim 2 will evaluate whether these quality measures differ between community care and
VHA direct care based on Veteran demographic characteristics (e.g., age, sex, rurality) and provisional
diagnosis (PTSD, depression, anxiety). Aim 3 will explore the mental health needs, social risks, and barriers to
care for the anticipated subset of Veterans who do not complete their first appointment within 8-weeks and 4-
months of their referral date. Methods: To assess study aims, we will recruit a total cohort of 224 Veterans with
PTSD, depression, or anxiety who are newly referred to community care or VHA (N=112 per care delivery
group) for psychotherapy within VISNs 16 and 17. Veterans will complete an online survey at baseline, 8-
weeks, and 4-months after their referral date. Path to translation/implementation: Study findings will be
disseminated to key audiences to inform administrative and policy decisions, clinical practices, and Veteran
care choices. Key audiences include Office of Integrated Veteran Care, Office of Health Equity, VISN 16 and
17 mental health leaders, other VHA researchers and employees, as well as Veterans and their families.
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