Dual use of VA and non-VA hospitals by Veterans with multiple hospitalizations.

Alan N West,Mary E Charlton,Mary Vaughan-Sarrazin

doi:10.1186/s12913-015-1069-8

Alan N West, Mary E Charlton + Show 1 more

Open Access

https://doi.org/10.1186/s12913-015-1069-8

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Abstract

BackgroundVeterans who are hospitalized in both VA and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care. To determine the characteristics of these “dual users,” we analyzed administrative hospital discharge data for VA-enrolled veterans of any age in seven states, including any VA or non-VA hospitalizations they had in 2004–2007.MethodFor VA enrollees in Arizona, Iowa, Louisiana, Florida, South Carolina, Pennsylvania, or New York in 2007, we merged 2004–2007 discharge data for all VA hospitalizations and all non-VA hospitalizations listed in state health department or hospital association databases. For patients hospitalized in 2007, we compared those younger or older than 65 years who had one or multiple hospitalizations during the year, split into users of VA hospitals, non-VA hospitals, or both (“dual users”), on demographics, priority for VA care, travel times, principal diagnoses, co-morbidities, lengths of stay, and prior (2004–2006) hospitalizations, using chi-square analysis or ANOVA. Multiply hospitalized patients were compared with multinomial logistic regressions to predict non-VA and dual use. Payers for non-VA hospitalizations also were compared across groups.ResultsOf unique inpatients in 2007, 38 % of those 65 or older were hospitalized more than once during the year, as were 32 % of younger patients; 3 and 8 %, respectively, were dual users. Dual users averaged the most index-year (3.7) and prior (1.5) hospitalizations, split evenly between VA and non-VA. They also had higher rates of admission for circulatory diseases, symptoms/signs/ill-defined conditions, and injury and poisoning, and more admissions for multiple diagnostic categories; among younger patients they had the highest rate of mental disorders admissions. Higher income, non-rural residence, greater time to VA care, lower VA priority, prior non-VA hospitalization, no prior VA hospitalization, and several medical categories predicted greater non-VA use. Among younger patients, however, mental disorders predicted more dual use but less exclusively non-VA use. Dual users’ non-VA admissions were more likely than others’ to be covered by payers other than Medicare or commercial insurance.ConclusionsYounger dual users require more medical and psychiatric treatment, and rely more on government funding sources. Effective care coordination for these inpatients might improve outcomes while reducing taxpayer burden.

Highlights

Veterans who are hospitalized in both Veterans Health Administration (VA) and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care
Greater reliance on non-VA care, on the other hand, has been associated with Medicare or commercial health insurance coverage [4], which is widespread among veterans – among active VA patients surveyed in 2007, for example, 79 % had some other type of health insurance [5]
Our objective was to determine whether multiply admitted patients, dual users of both VA and non-VA hospitalizations, have unique characteristics that policymakers should consider in resource allocation or for designing targeted care coordination efforts

Summary

Introduction

Veterans who are hospitalized in both VA and non-VA hospitals within a short timespan may be at risk for fragmented or conflicting care. Veterans who are enrolled in the VA healthcare system often use private sector medical services instead of or in addition to VA care, and several factors have been associated with whether VA or non-VA care is used. Enrollees who rely more on VA care tend to be sicker [1] and poorer [2] They tend to have been assigned higher “priority” for VA care [3], which a) is based on income and the extent to which injuries incurred during military service, or other catastrophic disabilities, impair functioning and the capacity for gainful employment, and b) determines whether veterans are eligible to receive certain services, reimbursed for driving to VA care, or required to make co-payments. Diagnosis is a factor – for example, VA enrollees younger than 65 rely more on non-VA care for most aggregated condition categories, with the exception of substance abuse, mental health disorders, or eye problems, for which reliance on VA care is greater [3]

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