Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

HSR&D Citation Abstract

Search | Search by Center | Search by Source | Keywords in Title

Medical Use for VHA-Medicare Dual Enrollees with New Onset Diabetes: Before and After Diagnosis

Shen Y, Sambamoorthi U, Soroka O, Rajan M, Pogach LM, Miller DR, Maney M. Medical Use for VHA-Medicare Dual Enrollees with New Onset Diabetes: Before and After Diagnosis. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 25; Orlando, FL.


Research Objective: To evaluate changes in utilization and reliance on VHA/Medicare of diabetes patients in 4 years before and 4 years after the diagnosis. Study Design: We examined patients inpatient/outpatient utilization for up to four years prior to or subsequent to the year of diagnosis. We also examined their reliance on VHA/Medicare measured by the percentages of using VHA only, private sector only and both systems separately for hospitalization or outpatient visits. Utilization patterns were further examined by different categories of care: microvascular, macrovascular, metabolic related diabetes complications and non-DM related complications. Population Studied: We used merged data from the 1999 Large Veteran Health Survey (LVHS) and the 1998-2004 Diabetes Epidemiology Cohort (DEpiC) to identify survey respondents who were newly diagnosed with diabetes in FY 2000-2004 and who had full year Medicare Fee-for-Service (FFS) coverage in each FY 2000- 2004. Principal Findings: There were 33,092 patients, 97.8% were male, 23% were younger than 65. Overall, 32% of patients had hospitalization within the year of diagnosis compared to 23.7% per year preceding the diagnosis and 27.4% after diagnosis. Patients had a mean of 15.7 outpatient visits during the year of diagnosis compared to 13 visits per year before diagnosis and 14.3 visits per year after diagnosis. Non-DM related hospitalizations accounted for 75% to 80% of all hospitalizations while non-DM related visits arranged from 90% to 80%. Patients reliance on VHA for both inpatient and outpatient care was greatest during the year of diagnosis. However, there was an overall increase in patients using Medicare only for inpatient care and both systems for outpatient care after the diagnosis. Patients were more likely to rely on VHA if they had macrovascular/microvascular complications, and were more likely to be Medicare reliant for non-DM related complications. Conclusions: Newly diagnosed diabetes veterans consumed more health care. Extra inpatient care triggered by diabetes diagnosis was most likely to be met by the private sector while the extra outpatient care need was met by both VHA and the private sector. Implications for Policy, Delivery, or Practice: This fragmentation of care highlights the need for coordination of care between VA PACT and private sector physicians in order to address continuity of care for this complex patient population, which presumably can result in improved health care for the Veterans.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.