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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)

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).

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.

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.

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.

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.

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