Study Shows Most Elderly Veterans Obtain High-Risk Surgeries in Non-VA Hospitals
Many veterans enrolled in the VA healthcare system also obtain healthcare from non-VA providers, particularly if they live far away from a VA healthcare facility. Most elderly veterans also are enrolled in Medicare, allowing for other options. This study sought to determine whether older veterans (age 65 and older) enrolled in VA healthcare obtain most high-risk surgeries in non-VA hospitals under Medicare, whether their residence (rural vs. suburban vs. urban) increases this reliance, and whether directing VA enrollees to better hospitals would add a substantial travel burden. Investigators analyzed data from 2000-2001 for VA enrollees age 65 and older who received any of 14 high-risk elective procedures, including heart (e.g., coronary artery bypass grafting), vascular (e.g., carotid endarterectomy), and cancer surgeries (e.g., colectomy).
Findings show that regardless of where they live, most elderly veterans obtain these high-risk surgeries in non-VA hospitals. Overall, veterans obtained 89% of their heart surgeries, 84% of their vascular surgeries, and 79% of their cancer surgeries in non-VA hospitals. Veterans living in urban settings were more likely to get heart or cancer surgeries in lower mortality hospitals, while veterans living in rural settings were most likely to get vascular surgeries in lower mortality hospitals. Average travel times to lower or higher mortality hospitals did not differ greatly; veterans generally traveled about as long to get to higher performance hospitals as to reach lower performance hospitals. Authors suggest that veterans might benefit from an effort to direct them to higher performance hospitals for these high-risk surgeries, and that this effort might best be initiated by focusing on veterans living beyond urban areas.
West A, Weeks W, and Wallace A. Rural veterans and access to high-quality care for high-risk surgeries. Health Services Research October 2008;43(5):
This work was funded by HSR&D. All authors are part of the VA Outcomes Group Research Enhancement Award Program, White River Junction VAMC.