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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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1005 — Dual Healthcare System Use Is Associated with Higher Rates of Hospitalization and Hospital Readmission among Veterans with Heart Failure

Axon RN, Charleston Health Equity and Rural Outreach Innovation Center (HEROIC); Gebregziabher M, Charleston Health Equity and Rural Outreach Innovation Center (HEROIC); Everett C, Charleston Health Equity and Rural Outreach Innovation Center (HEROIC); Hunt KJ, Charleston Health Equity and Rural Outreach Innovation Center (HEROIC);

Objectives:
Heart failure (HF) is one of the most frequent causes of hospital admission/readmission among Veterans. Dual use occurs when Veterans receive care from both VA and non-VA providers and facilities. Varied data suggest dual use is associated with increased healthcare utilization, costs, and worse health outcomes. This study aimed to determine rates of hospitalization and hospital readmission relative to dual use among Veterans with HF.

Methods:
We analyzed a retrospective regional cohort of 13,302 Veterans with HF hospitalized at least once for any cause between 2007 and 2011. Our analytic dataset included merged VA/ Medicare files plus an all-hospital, all-payor statewide dataset. Subjects were categorized based on their hospital utilization as all-VA users, all non-VA users, or dual users. We calculated annual rates of hospitalization for all causes and for HF as a principle diagnosis as well as rates of 30-day all-cause readmission and HF-specific readmission. We used Poisson regression to estimate rate ratios for hospital admission/readmission by group adjusted for age, sex, race/ethnicity, service-connected disability, rural/urban status, and comorbid illnesses.

Results:
There were 2,085 (15.67%) all-VA patients, 8426 (63.34%) all non-VA patients, and 2,791 (20.98%) dual users. In adjusted analyses, dual users had 9% higher annual risk for all-cause hospitalization (rate ratio (RR) 1.09, 95% CI 1.05, 1.13) and 59% higher risk for HF-specific hospitalization (RR 1.59, 95% CI 1.41, 1.8) compared to all-VA users. All non-VA users also had 3% higher annual risk for all-cause hospitalization (RR 1.03, 95% CI 1.00, 1.06) and 14% higher risk for HF-specific hospitalization (RR 1.14, 95% CI 1.02, 1.28) compared to all-VA users. The rate ratio for 30-day all cause readmission risk after an index hospitalization for HF was 1.50 (95% CI 1.32-1.69) for dual users, and 1.02 (95% CI 0.90-1.14) for all non-VA users, compared to all-VA users.

Implications:
Dual use is associated with higher rates of hospitalization and hospital readmission among Veterans with HF.

Impacts:
It is important to study determinants of dual use. Interventions should be devised to encourage continuity of care where possible and to improve the effectiveness and safety of dual use in instances where it is necessary and desired.