3016 — Dual Use of VA and non-VA Hospitals by Veterans with Multiple Hospitalizations

West AN, White River Junction VAMC; Charlton ME, Iowa City VAMC;

Objectives:
Veterans who are hospitalized in both VA and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care. To determine the characteristics of such "dual users," we analyzed administrative discharge data for any VA or non-VA hospitalizations undergone by VA-enrolled veterans in seven states.

Methods:
For veterans in the 2007 enrollment file living in Arizona, Iowa, Louisiana, Florida, South Carolina, Pennsylvania, or New York, we merged 2004-2007 data for any VA hospitalizations and any non-VA hospitalizations listed in state databases. For patients hospitalized in 2007, we compared those younger or older than 65 years who had one or multiple hospitalizations during the year, split into users of VA hospitals, non-VA hospitals, or both ("dual users"), on demographics, priority for VA care, travel times, principal diagnoses, co-morbidities, lengths of stay, and prior (2004-2006) hospitalizations, using chi-square analysis or ANOVA. Multiply hospitalized patients were compared with multinomial logistic regressions to predict non-VA and dual use. Payers for non-VA hospitalizations also were compared across groups.

Results:
Of unique inpatients in 2007, 38% of those 65 or older were hospitalized more than once during the year, as were 32% of younger patients; 3% and 8%, respectively, were dual users. Dual users averaged the most index-year (3.7) and prior (1.5) hospitalizations, split evenly between VA and non-VA. They also had higher rates of admission for circulatory diseases, symptoms/signs/ill-defined conditions, and injury and poisoning, and more admissions for multiple diagnostic categories; among younger patients they had the highest rate of mental disorders admissions. Higher income, non-rural residence, greater time to VA care, lower VA priority, prior non-VA hospitalization, no prior VA hospitalization, and several medical categories predicted greater non-VA use. Among younger patients, however, mental disorders predicted more dual use but less exclusively non-VA use. Dual users' non-VA admissions were more likely than others' to be covered by payers other than Medicare or commercial insurance.

Implications:
Dual users require more medical and psychiatric treatment, and rely more heavily on government funding sources.

Impacts:
Effective care coordination for VA patients who use non-VA hospitals might improve outcomes while reducing taxpayer burden.