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SHP 08-188 – HSR&D Study

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SHP 08-188
Geographic Variations in Patient Outcomes in the VHA Compared with the Medicare Advantage Programs
Alfredo J. Selim MD MPH
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: May 2008 - September 2008

BACKGROUND/RATIONALE:
The quest to further understand geographic variations in health care delivery leads inevitably to research on health care systems and their health outcomes. In a prior study that used data collected between 1998 and 2000, we found small geographic variations in health outcomes that favored the Veterans Health Administration (VHA) compared with the Medicare Advantage (MA) plans regarding geographic variations in health outcomes. Given the continuing improvements in the VHA in access to care and the management of patients with chronic conditions, it is possible that the results would be different with the use of contemporary health outcome databases.

OBJECTIVE(S):
We examined geographic variations in change in health status and/or mortality between the MA plans and the VHA among patients from racial/ethnic groups and/or with chronic conditions.

METHODS:
We used the Death-Master-File for vital status and the Short-Form 36 to determine physical (PCS) and mental (MCS) health at baseline and at 2-years. We compared the probability of being alive with the same or better (than would be expected by chance) PCS (or MCS) at 2-years and mortality, while adjusting for case-mix. We grouped patients into 4 geographic regions (Northeast, West, South, and Midwest).

FINDINGS/RESULTS:
The VHA patients had higher unadjusted probabilities of being alive with the same or better MCS at 2-years than the MA plans patients in all 4 geographic regions. After adjustment, these differences remained. The difference between VHA and MA plans ranged from 5.1% to 7.2%. Whites and African- Americans in the VHA had higher adjusted probabilities of being alive with the same or better PCS (or MCS) at 2-years than those in MA plans patients in all 4 geographic regions. Hispanics in the VHA had higher adjusted probabilities of being alive with the same or better PCS (or MCS) at 2-years than those in MA plans patients in the South and West. VHA patients with conditions such as diabetes, hypertension, stroke and COPD/asthma had higher adjusted probabilities of being alive with the same or better PCS (or MCS) at 2-years than the MA plans patients in all 4 geographic regions. Similar findings were seen in patients from selected racial/ethnic groups and chronic medical and mental health conditions such as diabetes, hypertension, stroke and depression.

IMPACT:
With the use of appropriate methodology, we found significant geographic variations in 2-year health outcomes that favor the VHA among minority patients and those with selected conditions among different geographic regions. The VHA's performance offers encouragement that the public sector can both finance and provide exemplary health care.

PUBLICATIONS:
None at this time.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: Epidemiology
Keywords: Care Management, Organizational issues, Patient outcomes
MeSH Terms: none

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