Researchers who are interested in small towns and rural communities in the United States often find that they need to conduct their own sample surveys because many large national surveys, such as the American Community Survey, do not collect enough representative responses to make precise estimates. In collecting their own survey data, researchers face a number of challenges, such as sampling and coverage limitations. This article summarizes those challenges and tests mail and Internet methodologies for collecting data in small towns and rural communities using the U.S. Postal Service’s Delivery Sequence File as a sample frame. Findings indicate that the Delivery Sequence File can be used to sample households in rural locations by sending them invitations via postal mail to respond to either paper-and-pencil or Internet surveys. Although the mail methodology is quite successful, the results for the Internet suggest that Web surveys alone exclude potentially important segments of the population of small towns and rural communities. However, Web surveys supplemented with postal questionnaires produce results quite similar to those of mail-only surveys, representing a possible cost savings for researchers who have access to Web survey capabilities.

Background: The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers. Objectives: The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider. Research Design: This was a retrospective, observational over fiscal years (FY) 2015–2018. Subjects: Veterans receiving primary care services paid for by the VA. Measures: Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year. Results: There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care. Conclusion: As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans’ use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans’ health care needs are met.

No abstract