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HSR&D 2004 National Meeting Abstracts


2069. Longitudinal Study of Changes in VHA Illness Burden Over Five Years
Christina M Daw, MPH, Houston Center for Quality of Care Utilization Studie, Houston VAMC and Baylor College of Medicine, M Byrne, Center for Bioethics and Health Law and Department of Medicine, University of Pittsburg, K Pietz, Houston Center for Quality of Care Utilization Studies, Houston VAM and Baylor College of Medicine, M Kuebeler, Houston Center for Quality of Care Utilization Studies, Houston VAMC, LA Petersen, Houston Center for Quality of Care Utilization Studies, Houston VAMC and Baylor College of Medicine

Objectives: To assess total and individual average illness burden in the VA over time.

Methods: Analysis of VA administrative databases for all VAMCs, for fiscal years 1998-2001. Each yearly cohort included all patients who received care at a VA hospital or outpatient clinic during that year. Individual illness burden was measured using relative risk scores derived from the Diagnostic Cost Groups risk adjustment software. We compared illness burden of veterans older vs. younger than 65 years of age, new vs. established VA users, and veterans who left vs. those not leaving the VA system the following year.

Results: Total (aggregate) illness burden increased 9.6%, while average illness burden decreased from 0.739 relative risk score in FY98 to 0.727 in FY01. New users and those leaving the VA system (not due to death) had substantially lower average illness burden (0.405 and 0.264 for FY98) than all veterans (0.739). The illness burden of elderly veterans decreased over time, while younger users’ burden increased. The number of users who completely leave the VA in any year fell over four years.

Conclusions: Following an increase in total users, total illness burden increased, yet average illness burden decreased. Substantial differences were noted in trends over time, within years among veterans who enter or leave the system, and between younger and older veterans.

Impact: The increasing numbers and retention of VA users may indicate increasing financial burden faced by patients or poorer access to non-VA health care.