Special Issue of Health Services Research Focuses on Linking VA and Non-VA Datasets to Improve Healthcare

BACKGROUND:
The theme of this special issue of Health Services Research is linking VA and non-VA datasets. Going back more than 20 years, VA's electronic health record system provides a vast repository of clinical information that researchers can aggregate to assess performance and quality improvement. VA researchers have used these data to study a wide variety of health services questions – from examining causes of quality variations to evaluating the impact of new innovations and programs. Researchers also have learned that there are limitations to working with VA data alone, since many Veterans also receive some portion of their care from non-VA providers that is not captured in the VA system. The articles in this special issue illustrate that researchers are increasingly linking diverse datasets as a valuable method for obtaining outcomes, treatments, and covariates that would otherwise be unavailable. All articles relied, in part, on the VA national database known as the Corporate Data Warehouse, which gathers data from VA's electronic health record system; several articles also relied on VA-Medicare linked data provided by the VA Information Resource Center (VIReC) under a longstanding interagency agreement with the Centers for Medicare & Medicaid Services. Other data sources include the U.S. Renal Data System, as well as individual state data (i.e., Oregon's prescription drug monitoring program).

Articles in this Supplement include, but are not limited to:

• Carlson and colleagues linked VA and DoD data with information from the Oregon Health Authority Prescription Drug Monitoring Program to examine the frequency with which post 9/11 Veterans were obtaining opioids and sedative-hypnotics. They found that more than one-third of Veterans who received opioids or sedative-hypnotics from VA had also received these prescriptions from non-VA prescribers at some point during the two-year study period.
• Hebert and colleagues linked 15 years of VA and Medicare claims data to a large survey of Veterans conducted in 1999 to examine how becoming age-eligible for Medicare changes Veterans' use of eight categories of VA and Medicare services over many years – and to compare survival between Veterans that were more or less reliant on VA services.
• Leveraging linked data, authors address a range of other topics, including VA and non-VA healthcare use and costs (Wang, et al.; Sarrazin, et al.; Hebert, et al.; Vanneman, et al; Liu, et al.; and Lei, et al.), medication use (Thorpe, et al.; Carlson, et al.; and Chiu, et al.), and the impact of homelessness on healthcare use and costs (Nelson, et al., and Trivedi, et al.). Two studies linked Medicare data to examine the impact of VA's patient aligned care team (PACT) intervention (Trivedi, et al., and Reddy et al.). Clinical conditions addressed in this special issue include mental health (Vanneman, et al.); dementia (Thorpe et al; Lei et al) end-stage kidney disease (Wang, et al), pain management (Carlson, et al; Chiu, et al), and infectious disease (Nelson, et al).

The lessons discussed in these articles are broadly applicable to both the challenges and benefits of data linkage as VA and non-VA researchers address questions that span different healthcare systems and services, and different conditions that affect patients.

Linking VA and non-VA Data to Address US Veteran Health Services Issues. Health Services Research. December 2018;53(S3):5129-5454.