退伍军人选择计划 (VCP) 于 2014 年实施，旨在通过向退伍军人提供购买的社区护理 (CC) 来帮助退伍军人获得更广泛的退伍军人健康管理局 (VHA) 设施之外的专门护理服务。描述 VCP 的患病率和模式在患有前列腺癌的退伍军人中实施 VCP 后，资助购买了 CC。这项队列研究使用了 2015 年 1 月 1 日至 2018 年 12 月 31 日期间诊断出的前列腺癌退伍军人的 VHA 管理数据。这些退伍军人是定期 VHA 初级保健用户。分析于 2023 年 3 月至 7 月期间进行。从住所到最近的 VHA 三级护理机构的驾驶距离（以英里为单位）。通过考虑 3 个因素来确定做出治疗决定的地点（VHA 或购买的 CC）：(1) 诊断活检的地点，(2) 大多数诊断后前列腺特异性抗原实验室检测的地点，以及 (3)大多数诊断后泌尿科护理的地点。主要结果是接受明确治疗以及按治疗类型（根治性前列腺切除术 [RP]、放射治疗 [RT] 或主动监测）以及到最近的 VHA 三级护理的距离划分的购买 CC 的比例设施。根据接受 Gleason 1 级前列腺癌的明确治疗（指南规定的低风险/有限的治疗益处）来评估质量。该队列包括 45029 名新诊断前列腺癌的退伍军人（平均 [SD] 年龄，67.1 [6.9] 岁）癌症;在这些患者中，28866 名（64.1%）接受了明确治疗。总体而言，56.8% 的患者从购买的 CC 环境中接受了明确治疗，占研究期间接受的所有 RP 护理的 37.5% 和所有 RT 护理的 66.7%。大多数接受主动监测管理的患者 (92.5%) 仍在 VHA 内。在研究期间，接受明确治疗的人数有所增加（从 2015 年的 5830 名患者增加到 2018 年的 9304 名患者），为居住在距 VHA 三级护理机构最远的患者购买的 CC 也有所增加。在购买的 CC 环境中，接受格里森 1 级前列腺癌明确治疗的可能性较高（调整后相对风险比，1.79；95% CI，1.65-1.93）。这项队列研究发现，接受明确治疗的退伍军人的百分比在研究期间，由 VCP 资助购买的 CC 设置显着增加。然而，增加获取机会可能会以低风险前列腺癌的低护理质量（过度治疗）为代价。

The Veterans Choice Program (VCP) was implemented in 2014 to help veterans gain broader access to specialized care outside of the Veterans Health Administration (VHA) facilities by providing them with purchased community care (CC).To describe the prevalence and patterns in VCP-funded purchased CC after the implementation of the VCP among veterans with prostate cancer.This cohort study used VHA administrative data on veterans with prostate cancer diagnosed between January 1, 2015, and December 31, 2018. These veterans were regular VHA primary care users. Analyses were performed from March to July 2023.Driving distance (in miles) from residence to nearest VHA tertiary care facility. The location (VHA or purchased CC) in which treatment decisions were made was ascertained by considering 3 factors: (1) location of the diagnostic biopsy, (2) location of most of the postdiagnostic prostate-specific antigen laboratory testing, and (3) location of most of the postdiagnostic urological care encounters.The main outcome was receipt of definitive treatment and proportion of purchased CC by treatment type (radical prostatectomy [RP], radiotherapy [RT], or active surveillance) and by distance to nearest VHA tertiary care facility. Quality was evaluated based on receipt of definitive treatment for Gleason grade group 1 prostate cancer (low risk/limited treatment benefit by guidelines).The cohort included 45 029 veterans (mean [SD] age, 67.1 [6.9] years) with newly diagnosed prostate cancer; of these patients, 28 866 (64.1%) underwent definitive treatment. Overall, 56.8% of patients received definitive treatment from the purchased CC setting, representing 37.5% of all RP care and 66.7% of all RT care received during the study period. Most patients who received active surveillance management (92.5%) remained within the VHA. Receipt of definitive treatment increased over the study period (from 5830 patients in 2015 to 9304 in 2018), with increased purchased CC for patients living farthest from VHA tertiary care facilities. The likelihood of receiving definitive treatment of Gleason grade group 1 prostate cancer was higher in the purchased CC setting (adjusted relative risk ratio, 1.79; 95% CI, 1.65-1.93).This cohort study found that the percentage of veterans receiving definitive treatment in VCP-funded purchased CC settings increased significantly over the study period. Increased access, however, may come at the cost of low care quality (overtreatment) for low-risk prostate cancer.