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CDA 13-024
Economic Impact of Dual Use and Patient Choice in Primary Care
Edwin S. Wong PhD MA
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: September 2013 - August 2018

BACKGROUND/RATIONALE:
Most Veterans enrolled in VA also have healthcare access through other health programs. Dual use of VA and non-VA care is potentially problematic for reasons such as duplication of services, fragmentation or discontinuity of care and challenges in communication across health systems that limit providers' ability to make fully informed treatment decisions. Despite the high rate of dual use among Veterans, current understanding of its underlying causes and economic implications is incomplete. The extent to which policy changes, such as the Affordable Care Act (ACA), affects Veterans' dual use of VA and non-VA care has not been examined. Analysis of Veterans' health choices following Massachusetts' healthcare reform in 2006 may provide valuable insights for the impact ACA on use of VA care because many components of the two policy changes are similar.

OBJECTIVE(S):
This research investigated economic and policy factors impacting Veterans' interaction with VA and other health systems. Aims 1 and 2 examined the potential impact of ACA on Veterans' enrollment in VA, utilization of VA outpatient services, costs and dual use. Aim 3 identified patient-reported predictors of dual VA and non-VA health service use.

METHODS:
All aims employed retrospective, observational analyses using administrative and survey data. Aim 1 examined changes in VA, private insurance and Medicaid enrollment among a representative sample of New England Veterans from the Current Population Survey during 2003-2013. Aims 2 and 3 used VA and Medicare administrative data from fiscal year (FY) 2004 through FY2013 and examine VA outpatient utilization, costs and dual use (measured as reliance on VA care) among all VA enrolled veterans. Analyses for Aims 1 and 2 employed a quasi-experimental study design comparing changes in outcomes before and after healthcare reform between respective groups of Massachusetts and other New England Veterans. In Aim 3, administrative data were linked to survey data from the VA Survey of Healthcare Experiences of Patients to identify patient-reported experience variables that were predictive of increased VA reliance. Traditional regression models were applied to examine which patient-reported variables were associated with greater VA reliance. In addition, we measured the proportion of variation in reliance explained by patient-reported experiences and to determine the extent to which adding these variables to a prediction model could improve the ability to accurately predict future reliance. Several machine learning algorithms including regularized regression, decision trees and neural networks were applied to understand whether alternative models could help improve predictive accuracy.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
A more comprehensive understanding of the factors predictive of dual use, including patient-reported perceptions of VA care and policy changes such as ACA, is significant for fiscal planning and the efficient allocation of health resources in VA. VA currently incorporates Veterans' expected reliance on VA care in projection models used for developing annual budget requests to Congress. Better predictions of dual use will ensure VA receives funding levels that balance Veterans' health needs and fiscal responsibility. Determining the role of primary care perceptions in patients' healthcare choices will also help VA improve healthcare delivery through the Patient Aligned Care Team initiative.

PUBLICATIONS:

Journal Articles

  1. Hebert PL, Wong ES, Reddy A, Batten A, Gunnink E, Wagner TH, Liu CF. Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans. Medical care. 2020 Aug 1; 58(8):710-716.
  2. Wong ES, Oddo VM, Jones-Smith JC. Are Housing Prices Associated with Food Consumption? International journal of environmental research and public health. 2020 May 30; 17(11).
  3. Schuttner L, Reddy A, White AA, Wong ES, Liao JM. Quality in the Context of Value: Reliability of Quality Metrics in an Academic Health System Shifting Toward Value-Based Payments. American journal of medical quality : the official journal of the American College of Medical Quality. 2020 May 5; 1062860620917205.
  4. Hernandez SE, Sylling PW, Mor MK, Fine MJ, Nelson KM, Wong ES, Liu CF, Batten AJ, Fihn SD, Hebert PL. Developing an Algorithm for Combining Race and Ethnicity Data Sources in the Veterans Health Administration. Military medicine. 2020 Mar 2; 185(3-4):e495-e500.
  5. Rinne ST, Mohr DC, Swamy L, Blok AC, Wong ES, Charns MP. National Burnout Trends Among Physicians Working in the Department of Veterans Affairs. Journal of general internal medicine. 2020 May 1; 35(5):1382-1388.
  6. Reddy A, Gunnink E, Taylor L, Wong E, Batten AJ, Fihn SD, Nelson KM. Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation. JAMA Network Open. 2020 Feb 5; 3(2):e1920500.
  7. Liu CF, Hebert PL, Douglas JH, Neely EL, Sulc CA, Reddy A, Sales AE, Wong ES. Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health services research. 2020 Apr 1; 55(2):178-189.
  8. Liu CF, Hebert P, Wong ES, Nelson K, Maynard C. Midlife mortality in White non-Hispanic male veterans enrolled in Department of Veterans Affairs primary care, 2003-2014. Heliyon. 2020 Jan 1; 6(1):e03328.
  9. Wong ES, Schuttner L, Reddy A. Does machine learning improve prediction of VA primary care reliance? The American journal of managed care. 2020 Jan 1; 26(1):40-44.
  10. Schuttner L, Reddy A, Rosland AM, Nelson K, Wong ES. Association of the Implementation of the Patient-Centered Medical Home with Quality of Life in Patients with Multimorbidity. Journal of general internal medicine. 2020 Jan 1; 35(1):119-125.
  11. Wong ES, Maciejewski ML, Hebert PL, Reddy A, Liu CF. Predicting Primary Care Use Among Patients in a Large Integrated Health System: The Role of Patient Experience Measures. Medical care. 2019 Aug 1; 57(8):608-614.
  12. Augustine MR, Nelson KM, Wong ES. Low and Higher Wage Workers Report No Differences in Four Barriers to Primary Care Access. Population health management. 2020 Apr 1; 23(2):115-123.
  13. Augustine MR, Nelson KM, Fihn SD, Wong ES. Patient-Reported Access in the Patient-Centered Medical Home and Avoidable Hospitalizations: an Observational Analysis of the Veterans Health Administration. Journal of general internal medicine. 2019 Aug 1; 34(8):1546-1553.
  14. Wong ES, Maciejewski ML, Hebert PL, Fortney JC, Liu CF. Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees. Administration and policy in mental health. 2019 Mar 1; 46(2):145-153.
  15. Adams SV, Mader MJ, Bollinger MJ, Wong ES, Hudson TJ, Littman AJ. Utilization of Interactive Clinical Video Telemedicine by Rural and Urban Veterans in the Veterans Health Administration Health Care System. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2019 Jun 1; 35(3):308-318.
  16. Trivedi R, Sylling P, Post EP, Wong ES, Mori AM, Fihn SD, Nelson K. Comparing Preventable Hospitalizations Among Veterans With and Without Mental Illnesses Before and After Implementation of PACT. Psychiatric services (Washington, D.C.). 2018 Dec 1; 69(12):1252-1258.
  17. Wong ES, Yoon J, Piegari RI, Rosland AM, Fihn SD, Chang ET. Identifying Latent Subgroups of High-Risk Patients Using Risk Score Trajectories. Journal of general internal medicine. 2018 Dec 1; 33(12):2120-2126.
  18. Reddy A, Wong E, Canamucio A, Nelson K, Fihn SD, Yoon J, Werner RM. Association between Continuity and Team-Based Care and Health Care Utilization: An Observational Study of Medicare-Eligible Veterans in VA Patient Aligned Care Team. Health services research. 2018 Dec 1; 53 Suppl 3:5201-5218.
  19. Hebert PL, Batten AS, Gunnink E, Reddy A, Wong ES, Fihn SD, Liu CF. Reliance on Medicare Providers by Veterans after Becoming Age-Eligible for Medicare is Associated with the Use of More Outpatient Services. Health services research. 2018 Dec 1; 53 Suppl 3:5159-5180.
  20. Liu CF, Batten A, Wong ES, Fihn SD, Hebert PL. Fee-for-Service Medicare-Enrolled Elderly Veterans Are Increasingly Voting with Their Feet to Use More VA and Less Medicare, 2003-2014. Health services research. 2018 Dec 1; 53 Suppl 3:5140-5158.
  21. Augustine MR, Nelson KM, Fihn SD, Wong ES. How Are Patients Accessing Primary Care Within the Patient-Centered Medical Home? Results From the Veterans Health Administration. The Journal of ambulatory care management. 2018 Jul 1; 41(3):194-203.
  22. Johnson V, Wong E, Lampman M, Curtis I, Fortney J, Kaboli P, Fihn S, Nelson K. Comparing Patient-Centered Medical Home Implementation in Urban and Rural VHA Clinics: Results From the Patient Aligned Care Team Initiative. The Journal of ambulatory care management. 2018 Jan 1; 41(1):47-57.
  23. Rosland AM, Wong E, Maciejewski M, Zulman D, Piegari R, Fihn S, Nelson K. Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study. Health services research. 2018 Aug 1; 53(4):2503-2522.
  24. Rinne ST, Graves MC, Bastian LA, Lindenauer PK, Wong ES, Hebert PL, Liu CF. Association between length of stay and readmission for COPD. The American journal of managed care. 2017 Aug 1; 23(8):e253-e258.
  25. Meo N, Wong E, Sun H, Curtis I, Batten A, Fihn SD, Nelson K. Elements of the Veterans Health Administration Patient-Centered Medical Home are Associated with Greater Adherence to Oral Hypoglycemic Agents in Patients with Diabetes. Population health management. 2018 Apr 1; 21(2):116-122.
  26. Rinne ST, Hebert PL, Wong ES, Au DH, Bastian LA, Nembhard IM, Neely EL, Sulc CA, Liu CF. Organizational Practices Affecting Chronic Obstructive Pulmonary Disease Readmissions. American journal of respiratory and critical care medicine. 2017 May 1; 195(9):1269-1272.
  27. Hebert PL, Howell EA, Wong ES, Hernandez SE, Rinne ST, Sulc CA, Neely EL, Liu CF. Methods for Measuring Racial Differences in Hospitals Outcomes Attributable to Disparities in Use of High-Quality Hospital Care. Health services research. 2017 Apr 1; 52(2):826-848.
  28. Wong ES, Rosland AM, Fihn SD, Nelson KM. Patient-Centered Medical Home Implementation in the Veterans Health Administration and Primary Care Use: Differences by Patient Comorbidity Burden. Journal of general internal medicine. 2016 Dec 1; 31(12):1467-1474.
  29. Wong ES, Maciejewski ML, Hebert PL, Batten A, Nelson KM, Fihn SD, Liu CF. Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use? Medical care research and review : MCRR. 2018 Feb 1; 75(1):33-45.
  30. Bouldin ED, Littman AJ, Wong E, Liu CF, Taylor L, Rice K, Reiber GE. Medicare-VHA dual use is associated with poorer chronic wound healing. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2016 Sep 1; 24(5):913-922.
  31. Wong ES, Rinne ST, Hebert PL, Cook MA, Liu CF. Hospital Distance and Readmissions Among VA-Medicare Dual-Enrolled Veterans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2016 Sep 1; 32(4):377-386.
  32. Hernandez SE, Taylor L, Grembowski D, Reid RJ, Wong E, Nelson KM, Liu CF, Fihn SD, Hebert PL. A First Look at PCMH Implementation for Minority Veterans: Room for Improvement. Medical care. 2016 Mar 1; 54(3):253-61.
  33. Rinne ST, Liu CF, Wong ES, Hebert PL, Heidenreich P, Bastian LA, Au DH. Organizational structure for chronic heart failure and chronic obstructive pulmonary disease. The American journal of managed care. 2016 Mar 1; 22(3):e82-7.
  34. Rinne ST, Wong ES, Hebert PL, Au DH, Lindenauer PK, Neely EL, Sulc CA, Liu CF. Weekend Discharges and Length of Stay Among Veterans Admitted for Chronic Obstructive Pulmonary Disease. Medical care. 2015 Sep 1; 53(9):753-7.
  35. Wong ES, Hebert PL, Nelson KM, Hernandez SE, Sylling PW, Fihn SD, Liu CF. Local Area Unemployment and the Demand for Inpatient Care Among Veterans Affairs Enrollees. Medical care research and review : MCRR. 2015 Aug 1; 72(4):468-80.
  36. Wong SP, Kreuter W, Curtis JR, Hall YN, O'Hare AM. Trends in in-hospital cardiopulmonary resuscitation and survival in adults receiving maintenance dialysis. JAMA internal medicine. 2015 Jun 1; 175(6):1028-35.
  37. Rinne ST, Wong ES, Lemon JM, Perkins M, Bryson CL, Liu CF. Survey nonresponders incurred higher medical utilization and lower medication adherence. The American journal of managed care. 2015 Jan 1; 21(1):e1-8.
  38. Sylling PW, Wong ES, Liu CF, Hernandez SE, Batten AJ, Helfrich CD, Nelson K, Fihn SD, Hebert PL. Patient-centered medical home implementation and primary care provider turnover. Medical care. 2014 Dec 1; 52(12):1017-22.
  39. Hsu C, Lemon JM, Wong ES, Carson-Cheng E, Perkins M, Nordstrom MS, Liu CF, Sprague C, Bryson CL. Factors affecting medication adherence: patient perspectives from five veterans affairs facilities. BMC health services research. 2014 Nov 13; 14(1):533.
  40. Wong ES, Maciejewski ML, Herbert PL, Bryson CL, Liu CF. Massachusetts health reform and Veterans Affairs health system enrollment. The American journal of managed care. 2014 Aug 1; 20(8):629-36.
  41. Au DH, Wong ES. Use of intensive care and healthcare reform: more questions following the Massachusetts experience*. Critical care medicine. 2014 Apr 1; 42(4):970-1.
  42. Wong ES, Hebert PL, Hernandez SE, Batten A, Lo S, Lemon JM, Fihn SD, Liu CF. Association between local area unemployment rates and use of Veterans Affairs outpatient health services. Medical care. 2014 Feb 1; 52(2):137-43.
Center Product

  1. Liu C, Wong ES, Rajan S, Fortney JC. Implementation Activities Costing Tool. 2016 Jun 15.
CYBR

  1. Wong ES. Patient Reported Access to VA Healthcare and Veterans' Use of Primary Care Services. HSR&D Cyberseminars [Cyberseminar]. Patient Aligned Care Teams (PACT) Demonstration Labs. 2016 Jul 20.
  2. Wong ES, Maciejewski ML, Hebert PL, Liu C. Implications of the Affordable Care Act for Use of VA Primary Care: Lessons from the Massachusetts Health Reform. [Cyberseminar]. 2014 Jun 18.
Conference Presentations

  1. Liu C, Wong ES, Fihn SD. Changes in Veterans Affairs Health System Enrollment and Utilization Following Affordable Care Act Implementation. Poster session presented at: VA Boston VAMC Annual Research Week; 2016 Jun 27; Boston, MA.
  2. Wong ES. Changes in Veterans Affairs Health System Enrollment and Utilization Following Affordable Care Act Implementation. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  3. Wong ES. Massachusetts Health Reform and Use of Mental Health Services in Veterans Health Care System. Session: Behavioral Health. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  4. Wong ES, Nelson KM. Is Patient-Reported Access to VHA Primary Care Associated with Preventable Hospitalizations? Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  5. Wong ES, Nelson KM. Longer Wait Times for VA Appointments Affect Veterans' Future Use of VA Primary Care. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  6. Wong ES, Nelson KM, Hebert PL. A First Look at PCMH Associated Changes to Utilization for Minority Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  7. Fihn SD, Liu C, Wong ES. Massachusetts Health Reform and Use of Mental Health Services in Veterans Health Care System. Poster session presented at: VA Brooke Army Medical Center Grand Rounds; 2016 Jun 26; Boston, MA.
  8. Hebert PL, Wong ES, Zeliadt SB, Liu C. Health and Social Risk Characteristics of Veterans Who Choose to Rely on the VA for Primary Care. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 26; Boston, MA.
  9. Liu C, Wong ES. Organizational Factors Associated with Length of Stay for Veterans with COPD. Paper presented at: American Thoracic Society Annual International Conference; 2016 Jun 1; San Francisco, CA.
  10. Liu C, Wong ES. Organizational Factors Associated with Length of Stay for Veterans with COPD. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 1; Boston, MA.
  11. Wong ES, Hebert PL, Liu C. The Relationships between Resource Utilization in an Index Admission and Readmission and Post-discharge Costs for Patients with COPD. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 1; Boston, MA.
  12. Wong ES, Liu C, Nelson KM, Fihn SD, Hebert PL. Patient-Reported Wait Times for VA Appointments Affect Veterans' Future Use of Primary Care. Poster session presented at: American Society of Health Economists Annual Conference; 2016 Jun 1; Boston, MA.
  13. Zeliadt SB, Liu C, Wong ES. Validity of Geographic Instrumental Variables for Comparing Care Provided to Veterans by VA Versus Medicare Providers. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 1; Boston, MA.
  14. Fortney JC, Nelson KM, Wong ES. Comparing Patient-Centered Medical Home Implementation in Urban and Rural VHA Clinics: Results from the Patient Aligned Care Team (PACT) Initiative. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 12; Hollywood, FL.
  15. Wong ES, Nelson KM. Access in the VA: Which Veterans Are Using Patient-Centered Primary Care Services? Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 12; Hollywood, FL.
  16. Wong ES, Rosland AM, Fihn SD, Nelson KM. Implementation of the Patient Aligned Care Team Initiative and Primary Care Use: Differences by Patient Comorbidity Burden. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 10; Philadelphia, PA.
  17. Wong ES, Maciejewski ML, Hebert PL, Batten AJ, Nelson KM, Fihn SD, Liu C. Did Massachusetts Health Reform Impact VA Primary Care Use? Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  18. Wong ES, Maciejewski ML, Hebert PL, Batten AJ, Nelson KM, Fihn SD, Liu C. Did Massachusetts Health Reform Increase Use of the Veterans Affairs Health Care System? Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
  19. Wong ES, Rosland AM, Fihn SD, Nelson KM. Implementation of the Veterans Health Administration Patient Centered Medical Home Initiative and Primary Care Use: Differences by Clinic Comorbidity Burden. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 15; Minneapolis, MN.
  20. Wong ES, Hebert PL, Rinne S, Au DH, Liu C. Is Hospital Distance Associated With 30-Day Readmission and Mortality among Veterans Health Administration Enrollees? Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jun 13; Philadelphia, PA.
  21. Hebert PL, Piegari R, Wong ES, Liu C, Sylling PW, Hernandez SE, Batten AJ, Nelson KM, Fihn SD. Trends in Hospitalizations for Ambulatory Care Sensitive Conditions in Veterans Administration Hospitals compared to non-Federal Hospitals, 2003 to 2010. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA.
  22. Nelson KM, Helfrich CD, Sun H, Hebert PL, Liu C, Dolan D, Taylor L, Wong ES, Maynard CC, Hernandez S, Sanders W, Randall I, Curtis I, Schectman G, Stark R, Fihn SD. Implementation of the Patient Centered Medical Home (PCMH) in the Veterans Health Administration (VHA); Associations with clinical outcomes, patient satisfaction, provider burnout and utilization. Presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA.
  23. Rinne S, Wong ES, Perkins M, Bryson CL, Liu C. Non-responders to a patient satisfaction survey incurred higher medical utilization and lower medication adherence. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 10; San Diego, CA.
  24. Trivedi RB, Sylling PW, Wong ES, Liu C, Hebert PL, Kivlahan DR, Post EP, Pomerantz AS, Fihn SD, Nelson KM. Relationship of Mental Illness and Ambulatory Care Sensitive Condition (ACSC)-Related Hospitalizations among Veterans seen in VHA Primary Care. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  25. Hernandez SE, Nelson KM, Sun H, Liu C, Wong ES, Sylling PW, Helfrich CD, Fihn SD, Hebert PL. A First Look at PCMH Implementation for Minority Veterans: Room for Improvement. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
  26. Wong ES, Hebert PL, Hernandez SE, Batten A, Sylling PW, Fihn SD, Liu C. Relationship between Local Area Unemployment and Preventable Hospitalizations. Paper presented at: AcademyHealth Annual Research Meeting; 2014 Jun 8; San Diego, CA.
  27. Meo NO, Wong ES, Bryson CL, Sun H, Curtis I, Gupta I, Batten AJ, Fihn SD, Nelson KM. Organizational factors associated with medication adherence after patient centered medical home transformation. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  28. Meo NO, Wong ES, Sun H, Batten AJ, Gupta I, Bryson CL, Fihn SD, Nelson KM. Features of the Patient Centered Medical Home Associated with Medication Adherence: Results from the VHA Patient Aligned Care Team (PACT) Initiative. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  29. Nelson KM, Helfrich CD, Sun H, Hebert PL, Liu C, Dolan E, Taylor L, Wong ES, Maynard CC, Hernandez H, Sanders W, Curtis I, Randall I, Shectman G, Stark R, Fihn SD. Measuring the Patient Centered Medical Home Implementation in the VHA. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  30. Nelson KM, Helfrich CD, Sun H, Hebert PL, Liu C, Dolan E, Taylor L, Wong ES, Maynard CC, Hernandez S, Sanders W, Randall I, Curtis I, Schectman G, Stark R, Fihn SD. Implementation of the Patient Centered Medical Home (PCMH) in the Veterans Health Administration (VHA); Associations with clinical outcomes, patient satisfaction, provider burnout and utilization. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  31. Sylling P, Wong ES, Hernandez S, Batten AJ, Helfrich CD, Nelson KM, Fihn SD, Hebert PL. Patient-Centered Medical Home (PCMH) Implementation and Provider Job Turnover. Presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 25; San Diego, CA.
  32. Trivedi R, Sylling P, Wong ES, Liu C, Hebert PL, Kivlahan D, Post EP, Pomerantz AS, Fihn SD, Nelson KM. Relationship of Mental Illness and Ambulatory Care Sensitive Condition (ACSC)-Related Hospitalizations among Veterans seen in VA Primary Care. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2014 Apr 23; San Diego, CA.


DRA: Health Systems
DRE: Prevention, Technology Development and Assessment, Treatment - Preclinical
Keywords: none
MeSH Terms: none

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