TY - JOUR
T1 - Dual medicare and veteran health administration use and ambulatory care sensitive hospitalizations
AU - Ajmera, Mayank
AU - Wilkins, Tricia Lee
AU - Sambamoorthi, Usha
N1 - Publisher Copyright:
© Society of General Internal Medicine 2011.
PY - 2020
Y1 - 2020
N2 - OBJECTIVE: The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use. PARTICIPANTS: A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS). DESIGN/MEASUREMENTS: Cross-sectional analyses (N=44,988) of linked fee-for-service Medicare claims and survey data from multiple years of the MCBS (2001– 2005). Any ACSH and specific types of ACSH were measured using the list of prevention quality indicators developed by the Agency for Healthcare Research and Quality. Among veterans, dual Medicare/VHA use was defined as having inpatient or outpatient visits paid by VHA and consisted of three categories: 1) predominant-VHA use; 2) some VHA use and no VHA use. Unadjusted group differences in any ACSH were tested using chi-square tests. Logistic regressions were used to analyze the association between dual Medicare/VHA use and ACSH after controlling for demographic, socio-economic status, health status, functional status, smoking status and obesity. All analyses accounted for the complex design of the MCBS. RESULTS: Among inpatient users, 10.1% had ACSH events for acute conditions and 15.8% for chronic conditions. Among all survey respondents, 5% had any ACSH event. Among predominant-VHA users the rate was 4.9% and among veterans with some VHA use it was 3.7%. In bivariate and multivariate analyses, dual Medicare/ VHA use was not significantly associated with any ACSH. CONCLUSION: In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.
AB - OBJECTIVE: The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use. PARTICIPANTS: A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS). DESIGN/MEASUREMENTS: Cross-sectional analyses (N=44,988) of linked fee-for-service Medicare claims and survey data from multiple years of the MCBS (2001– 2005). Any ACSH and specific types of ACSH were measured using the list of prevention quality indicators developed by the Agency for Healthcare Research and Quality. Among veterans, dual Medicare/VHA use was defined as having inpatient or outpatient visits paid by VHA and consisted of three categories: 1) predominant-VHA use; 2) some VHA use and no VHA use. Unadjusted group differences in any ACSH were tested using chi-square tests. Logistic regressions were used to analyze the association between dual Medicare/VHA use and ACSH after controlling for demographic, socio-economic status, health status, functional status, smoking status and obesity. All analyses accounted for the complex design of the MCBS. RESULTS: Among inpatient users, 10.1% had ACSH events for acute conditions and 15.8% for chronic conditions. Among all survey respondents, 5% had any ACSH event. Among predominant-VHA users the rate was 4.9% and among veterans with some VHA use it was 3.7%. In bivariate and multivariate analyses, dual Medicare/ VHA use was not significantly associated with any ACSH. CONCLUSION: In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.
KW - ACSH
KW - Care coordination
KW - Dual utilization
KW - Veterans
UR - http://www.scopus.com/inward/record.url?scp=84858205548&partnerID=8YFLogxK
U2 - 10.1007/s11606-011-1788-4
DO - 10.1007/s11606-011-1788-4
M3 - Article
C2 - 21989620
AN - SCOPUS:84858205548
VL - 26
SP - S669-S675
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
ER -