TY - JOUR
T1 - Variations in VA and Medicare Use Among Veterans With Diabetes
T2 - Impacts on Ambulatory Care Sensitive Conditions Hospitalizations for 2008, 2009, and 2010
AU - Rose, Danielle E.
AU - Rowneki, Mazhgan
AU - Sambamoorthi, Usha
AU - Fried, Dennis
AU - Dwibedi, Nilanjana
AU - Tseng, Chin Lin
AU - Jani, Nisha
AU - Yano, Elizabeth M.
AU - Helmer, Drew A.
N1 - Funding Information:
Supported by VA HSR&D, IIR 12-401 (Helmer) Understanding Geographic Variations in Preventable Hospitalizations. E.M.Y. was funded by VA HSR&D Senior Research Career Scientist Award (Project #RCS 05-195).
Publisher Copyright:
© Copyright 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Introduction: VA and Medicare use among older Veterans has been considered fragmented care, however, it may represent access to needed care. Methods: The population studied were Veterans with diabetes, age 66 years and older, dually enrolled in VA and Medicare. Data Source/Study Setting: We conducted a dynamic retrospective cohort study with 2008, 2009, and 2010 as the outcome years (Ambulatory Care Sensitive Conditions Hospitalization (ACSC-H) or not). We analyzed administrative data to identify comorbidities; ambulatory care utilization to identify variations in use before hospitalization. We linked 2007 primary care (PC) survey data to assess if organizational factors were associated with ACSC-H. Measures and Analysis: We identified ACSC-Hs using a validated definition. We categorized VA/Medicare use as: single system; dual system: supplemental specialty care use; or primary care use. Using hierarchical logistic regression models, we tested for associations between VA/Medicare use, organizational characteristics, and ACSC-H controlling for patient-level, organizational-level, and area-level characteristics. Results: Our analytic population was comprised of 210,726 Medicare-eligible Veterans; more than one quarter had an ACSC-H. We found that single system users had higher odds of ACSC-H compared with dual system specialty supplemental care use (odds ratio, 1.14; 95% confidence interval, 1.09-1.20), and no significant difference between dual-system users. Veterans obtaining care at sites where PC leaders reported greater autonomy (eg, authority over personnel issues) had lower odds of ACSC-H (odds ratio, 0.74; 95% confidence interval, 0.59-0.92). Discussion: Our findings suggest that earlier assumptions about VA/Medicare use should be weighed against the possibility that neither VA nor Medicare may address complex Veterans' health needs. Greater PC leader autonomy may allow for tailoring of care to match local clinical contexts.
AB - Introduction: VA and Medicare use among older Veterans has been considered fragmented care, however, it may represent access to needed care. Methods: The population studied were Veterans with diabetes, age 66 years and older, dually enrolled in VA and Medicare. Data Source/Study Setting: We conducted a dynamic retrospective cohort study with 2008, 2009, and 2010 as the outcome years (Ambulatory Care Sensitive Conditions Hospitalization (ACSC-H) or not). We analyzed administrative data to identify comorbidities; ambulatory care utilization to identify variations in use before hospitalization. We linked 2007 primary care (PC) survey data to assess if organizational factors were associated with ACSC-H. Measures and Analysis: We identified ACSC-Hs using a validated definition. We categorized VA/Medicare use as: single system; dual system: supplemental specialty care use; or primary care use. Using hierarchical logistic regression models, we tested for associations between VA/Medicare use, organizational characteristics, and ACSC-H controlling for patient-level, organizational-level, and area-level characteristics. Results: Our analytic population was comprised of 210,726 Medicare-eligible Veterans; more than one quarter had an ACSC-H. We found that single system users had higher odds of ACSC-H compared with dual system specialty supplemental care use (odds ratio, 1.14; 95% confidence interval, 1.09-1.20), and no significant difference between dual-system users. Veterans obtaining care at sites where PC leaders reported greater autonomy (eg, authority over personnel issues) had lower odds of ACSC-H (odds ratio, 0.74; 95% confidence interval, 0.59-0.92). Discussion: Our findings suggest that earlier assumptions about VA/Medicare use should be weighed against the possibility that neither VA nor Medicare may address complex Veterans' health needs. Greater PC leader autonomy may allow for tailoring of care to match local clinical contexts.
KW - Medicare
KW - Veterans
KW - hospitalizations
KW - professional autonomy
KW - services
KW - utilization
UR - http://www.scopus.com/inward/record.url?scp=85065319329&partnerID=8YFLogxK
U2 - 10.1097/MLR.0000000000001119
DO - 10.1097/MLR.0000000000001119
M3 - Article
C2 - 31045693
AN - SCOPUS:85065319329
VL - 57
SP - 425
EP - 436
JO - Medical Care
JF - Medical Care
SN - 0025-7079
IS - 6
ER -