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HSR&D 2004 National Meeting Abstracts

1059. Most Veterans Obtain Cardiac Revascularization Outside VHA
Elliott S Fisher, MD, MPH, VA Medical & Regional Office Center, White River Junction VAMC, DM Bott, Dartmouth Medical School, D Bazos, VA Medical & Regional Office Center, White River Junction VAMC, SL Campbell, VHA Office of Quality and Performance, R Lombardo, New York State Department of Health, MJ Racz, New York State Department of Health, SM Wright, VHA Office of Quality and Performance, ES Fisher, Dartmouth Medical School and VA Outcomes Group, White River Junction VAMC

Objectives: VHA seeks to provide comprehensive, coordinated care through a regional referral network. However, many veterans use multiple healthcare systems to obtain care. We sought to determine whether veterans rely on VHA or private sector for cardiac revascularization.

Methods: Matching enrollment and utilization data from VHA to utilization data from New York’s Cardiac Surgery Reporting System (CSRS), we were able to create a comprehensive file of coronary artery bypass grafting (CABG) surgeries and percutaneous coronary interventions (PCI) provided to male enrolled veterans in New York in 1997. We determined the site of intervention (VHA or private sector) and risk-adjusted mortality quartile for private sector hospitals, and compared utilization rates by veterans to non-veterans for two age groups (45-64 and 65+).

Results: Male veterans aged 45-64 underwent more CABG (4.29/1000 vs. 2.82/1000, p<.001) and PCI (5.55/1000 vs. 4.32/1000, p<.001) than male non-veterans, while those aged 65+ underwent fewer CABG (7.57/1000 vs. 8.15/1000, p=.051) and PCI (6.59/1000 vs. 7.69/1000, p<.001). Older veterans who underwent private sector CABG were more likely to use hospitals ranked in the lowest versus highest quartile of risk-adjusted mortality (OR 1.30, 95% CI:1.03-1.64). Veterans aged 45-64 received 41% of their CABGs and 35% of their PCIs within VHA, while veterans 65 and older received 19% of their CABGs and 18% of their PCIs within VHA.

Conclusions: Both younger and older veterans receive the majority of their cardiovascular interventions in the private sector.

Impact: Efforts to improve care for veterans will require collaboration with private sector care systems.