Impact of the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act on Quality and Outcomes of Major Cardiovascular Procedures Among Veterans
Authors' conclusion
MISSION Act implementation was associated with substantial decreases in travel times among veterans who became geographically eligible for non-VA care. For these patients undergoing PCI or CABG, MISSION Act implementation was also associated with worsened 30-day MACE rates.
Study context
- Population
- Veterans receiving nonemergent/nonurgent percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) or aortic valve replacement (AVR) in non-VA hospitals under MISSION Act coverage or Veterans Affairs (VA) hospitals, 48 contiguous US states or DC, October 2016–September 2022PCI 43,000
- Exposure
- Veterans living far (>60 min) from nearest VA medical center (eligible for non-VA care under MISSION Act) vs near (≤60 min), before vs after MISSION implementation
- Outcome
- MACE (rehospitalization for CV cause or mortality within 30 days of procedure) and travel times for care
- Follow-up
- 30 days
Methodological detailsdifference-in-differences
- Difference-in-differences
Main finding
As reported in the abstract
Near
- PCI travel time change
- increased by 1.3 minutes
- CABG travel time change
- increased by 9.4 minutes
- AVR travel time change
- increased by 10.0 minutes
- PCI major adverse cardiovascular events (MACE) change
- decreased by 0.5 percentage points
- CABG MACE change
- decreased by 6.5 percentage points
Far
- PCI travel time change
- decreased by 29.2 minutes
- CABG travel time change
- decreased by 18.1 minutes
- AVR travel time change
- decreased by 23.0 minutes
- PCI MACE change
- increased by 2.3 percentage points
- CABG MACE change
- increased by 1.6 percentage points
PCI travel time change
Nearincreased by 1.3 minutes
Fardecreased by 29.2 minutes
CABG travel time change
Nearincreased by 9.4 minutes
Fardecreased by 18.1 minutes
AVR travel time change
Nearincreased by 10.0 minutes
Fardecreased by 23.0 minutes
PCI major adverse cardiovascular events (MACE) change
Neardecreased by 0.5 percentage points
Farincreased by 2.3 percentage points
CABG MACE change
Neardecreased by 6.5 percentage points
Farincreased by 1.6 percentage points
- PCI travel time
- difference in differences −30.5 minutes; P < 0.001
- CABG travel time
- difference in differences −27.4 minutes; P < 0.001
- AVR travel time
- difference in differences −33.1 minutes; P < 0.001
- PCI 30-day MACE
- difference in differences 2.8 percentage points; P < 0.001
- CABG 30-day MACE
- difference in differences 8.1 percentage points; P < 0.001
- AVR MACE rates not statistically different between the groups
- P = 0.45
Observational data: associations, not effects.
Original publication
Impact of the MISSION Act on Quality and Outcomes of Major Cardiovascular Procedures Among Veterans. JAMA. Published 26 August 2025. doi:10.
Summarised from the published abstract; every number is checked against it