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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3022 — Dual Use of VA and Non-VA Hospitalizations by VA Enrollees

West AN, Veterans Rural Health Resource Center, Eastern Region; Charlton ME, and Kaboli PJ, Veterans Rural Health Resource Center, Central Region;

Objectives:
To determine how VA-enrolled Veterans use either VA or non-VA hospitalizations for different diagnoses and procedures, comparing single admission patients to patients with multiple hospitalizations, particularly “dual users” of both VA and non-VA hospitals. Prior work, mostly limited to older, Medicare eligible Veterans, suggests substantial reliance on both systems.

Methods:
We acquired hospital discharge data (2004-2007) for VA enrollees in seven states (AZ, IA, LA, FL, SC, PA, NY), including all admissions to either VA (PTF data) or non-VA hospitals (state agency/ hospital association data). For each of three age ranges (young = 18-44, middle-aged = 45-64, elderly = 65+), we distinguished patients with only one versus > 1 admission in the four years (“single” vs. “multiple admits”), and within multiple admits, patients who used only VA or non-VA hospitals versus dual users. Using AHRQ’s Clinical Classification Software we assigned principal diagnoses and all procedures to major categories. Chi square analyses yielded unadjusted odds ratios for likelihood of using VA hospitals for particular diagnoses or procedures compared to all others.

Results:
Dual users comprised 10% of young, 13% of middle-aged, and 6% of elderly patients. Among patients younger than 65 who used only one care system (whether single or multiple admits), 3/10 of admissions were in VAMCs; for older (i.e., Medicare eligible) patients, 1/10 were VAMC admissions. In any age range, however, dual users obtained half of their hospitalizations in VA hospitals. Enrollees were relatively more likely to use VA hospitals for mental illness, substance abuse, neoplasms, digestive or musculoskeletal diseases, and certain procedures (diagnostics, transfusions, physical therapy). They were more likely to use non-VA hospitals for circulatory, respiratory, endocrine, nutritional, metabolic, or immune disorders, and certain procedures (cardiac, orthopedic). Surprisingly, distance to care and priority for VA services had a limited effect on choice of VA or non-VA care.

Implications:
Overall, dual users rely heavily on VA care. Among younger enrollees, dual users are the most likely to be hospitalized for mental illness, in either VA or non-VA hospitals.

Impacts:
Dual use of inpatient services is very common. Future research should determine if outcomes differ between dual users and single system users to inform targeted inventions promoting co-management and continuity of care.


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