Health Services Research & Development

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2006 HSR&D National Meeting Abstract


3007 — VHA and Non-VHA Post-Stroke Rehospitalization by Veterans with Acute Stroke

Author List:
Zheng Y (Rehabilitation Outcomes Research Center)
Jia H (Rehabilitation Outcomes Research Center)
Reker D (Rehabilitation Outcomes Research Center)
Cowper D (Rehabilitation Outcomes Research Center)
Wu S (Rehabilitation Outcomes Research Center)
Vogel B (Rehabilitation Outcomes Research Center)

Objectives:
The objective of this study was to assess the likelihood of 12-month post-stroke rehospitalization by veterans with stroke who used VHA only versus those who used multiple sources of care (VHA-Medicare, VHA-Medicaid, and VHA-Medicare-Medicaid).

Methods:
In a retrospective observational cohort study, 1,825 veterans who lived in Florida, were diagnosed with acute stroke, and were discharged alive at the index stroke were identified in 2000-2001 inpatient databases from three sources (VHA, Veteran Medicare, and Florida Medicaid). The cohort was categorized into four user groups (VHA-only, VHA-Medicare, VHA-Medicaid, and VHA-Medicare-Medicaid) based upon their use of each healthcare program. General rehospitalization and stroke rehospitalization referred to 12-month post-stroke rehospitalization status (yes, no) of the patients. A logistic regression model was fitted for each measure adjusting for patients’ demographic, clinical, pre- and post-stroke utilization, and other disease severity indicators.

Results:
The sample consisted of 30% VHA-only users, 60% VHA-Medicare users, 3% VHA-Medicaid users, and 7% VHA-Medicare-Medicaid users. Compared with other users: the VHA-Medicare users had a significantly larger proportion of patients who were white, married, older, and low priority for VHA healthcare (p<0.05); and the VHA-Medicaid users were significantly younger, unmarried, lower in comorbidity score, and had more hemorrhagic stroke (p<0.05). Our logistic models showed that the VHA-Medicare users (OR 1.5, p=0.001), the VHA-Medicaid users (OR 2.0, p=0.036), and the triple users (OR 14.7, p<0.0001) were more likely to be rehospitalized in general than the VHA-only users. The VHA-Medicare users (OR 3.2, p<0.0001), the VHA-Medicaid users (OR 3.1, p=0.001), and the triple users (OR 5.4, p<0.0001) were also more likely to be readmitted for recurrent stroke than the VHA–only users.

Implications:
Our findings indicate that increased healthcare eligibility for veterans with acute stroke in Florida is associated with both rehospitalization (any cause) and recurrent stroke rehospitalization.

Impacts:
Whether the above differences in likelihood reflect differences in quality of care, access to care, or patient clinical characteristics is a critical issue for VHA healthcare and is the subject of on-going research. Our findings can assist healthcare planners and clinicians in understanding the post-stroke inpatient utilization behavior and healthcare continuity of veterans with stroke.