Veterans reported high satisfaction with both VA and community care.

Most veterans preferred the VA for their general healthcare.

Veterans demonstrated no statistically significant difference in preference between VA and community cardiovascular care.

Satisfaction linked to communication, coordination, and staff quality.

The MISSION Act of 2018 expanded veterans' access to necessary care at non-Veterans Affairs (VA) facilities. The policy is intended to improve access to timely, high-quality care—particularly for specialized procedures like transcatheter aortic valve replacement (TAVR). However, veterans' preferences regarding specialty care in the community vs within the VA system remain unexplored.

This cross-sectional quality improvement study surveyed veterans at an urban VA heart center who received referrals to community hospitals between 2018 and 2023 for structural heart disease care. The 14-item survey evaluated satisfaction across 3 key domains—communication, quality, and care coordination—along with overall satisfaction with community and VA care, and preferences for future care delivery settings.

Of 47 veterans who completed the survey, most (78.7%) preferred receiving care at a VA hospital (P < .0001). Veterans reported high satisfaction with both community (mean score 9.15/10) and VA-based care (9.19/10; P = .876). While 64% preferred the VA for future cardiovascular care, this trend did not reach statistical significance (P = .079). In contrast, 78.7% preferred the VA for general healthcare (P < .001). Satisfaction with community care was most strongly associated with staff competence (r = 0.839) and feeling their concerns were heard (r = 0.818). VA satisfaction correlated most strongly with care coordination (r = 0.789) and clear follow-up instructions (r = 0.729). Transportation challenges were reported by 17% of respondents and were significantly associated with preference for community care for general health (P < .001).

Veterans referred for cardiovascular procedures through the MISSION Act reported high satisfaction across settings but expressed a clear preference for VA-based care for general healthcare. These findings suggest that while community care is a valuable tool for improving access, investments in VA-based services remain critical to meeting veteran expectations and preserving care quality.

Published by Elsevier Inc.