Return to 2001 Abstacts List

A Hendricks, CHQOER; G Nugent, Cincinnati VAMC; M Render, Cincinnati VAMC

Objectives: This project evaluates the use of Veterans’ Administration (VA) health services by substance abusing veterans enrolled in one of the following treatment modalities after inpatient detoxification in a VA Medical Center (VAMC): 1) domiciliary follow-up care; 2) outpatient psychiatric follow-up care; and 3) no psychiatric follow-up care.

Methods: We identified all veterans receiving inpatient detoxification in VAMCs during FY1998 (DRG 434, 435). We measured baseline inpatient and outpatient utilization using data from VA files for FY 1997 and tested for sorting of high and low users into follow-up care classifications using t-tests. We compared group inpatient health services utilization for 12 months following detoxification using survival analyses.

Results: The 36,195 veterans receiving inpatient detoxification during FY1998 required 406,832 inpatient days and 3,015,044 outpatient clinic visits prior to admission. Of these veterans, 13.5% received follow-up care in a VA domiciliary, 73% received outpatient psychiatric follow-up care, and 13.5% received no VA psychiatric follow-up care. Patients receiving domiciliary follow-up care used VA inpatient and outpatient psychiatric services significantly more (p <= .05) in 11 of the 12 months prior to detoxification than any of the other follow-up groups. These patients also used significantly more outpatient medical/surgical services (p<=.05) in the year prior to detoxification than patients in the other follow-up groups. Veterans who did not receive any psychiatric follow-up care required significantly more medical and surgical inpatient days (p<=.05) during the year prior to inpatient detoxification than any other group. In addition, patients who did not receive VA psychiatric follow-up care had a longer period of time without VA inpatient readmission and a lower probability of VA inpatient readmission during the 12 months after detoxification than patients in the other follow-up groups.

Conclusions: Most veterans who receive inpatient detoxification in a VAMC receive psychiatric follow-up care on an outpatient basis. Veterans admitted to a VA domiciliary for their follow-up care have greater prior psychiatric utilization than the other groups. This may reflect either a greater need or a greater reliance on VA care. Veterans who do not receive VA follow-up care appear to have more serious medical and surgical problems than veterans in the other follow-up groups.

Impact: This project highlights the differences in health services use and outcomes among substance abusing veterans enrolled in VA follow-up care programs after inpatient detoxification. Future evaluations of VA care for substance abuse patients must control for patient sorting at either the individual or program level. Outcomes relying on changes in VA utilization must recognize the greater prior service use by patients admitted to domiciliaries, even compared to those receiving other types of psychiatric follow-up care. Longitudinal VISN-level and patient-level survival analyses are needed to understand the long-term effectiveness of VA follow-up care for inpatient detoxification.