Veterans Affairs Health Care Utilization Research Articles

Patterns of Treatment Utilization Across the Perinatal Period in the Center for Maternal and Infant Outcomes and Research in Translation (COMFORT) Veterans Study

Background: Women Veterans using Veterans Affairs (VA) maternity care represent a high-risk population owing to the high prevalence of psychiatric disorders, such as depression, anxiety, and posttraumatic stress disorder (PTSD). Given the increased risk of symptom recurrence and/or medication discontinuation during pregnancy, the aim of this study was to understand the relationship between mental health and health care utilization in pregnant Veterans within the Veterans Health Administration (VHA). Materials and Methods: Women with a confirmed pregnancy were recruited from 15 VA sites across the United States. Data sources included diagnosis codes, clinic stop codes for outpatient visits, and 30-day antidepressant prescriptions in the electronic health record. Results: Overall, mental health visits increased slightly from prepregnancy to pregnancy before decreasing in the postpartum period. For women with a prepregnancy diagnosis of depression, anxiety, and/or PTSD, there was an increase in psychotherapy utilization during the pregnancy and postpartum periods, whereas the percentage of women utilizing antidepressants only or antidepressants plus therapy decreased during these same time periods. A small proportion of women with histories of mental health conditions did not utilize mental health care within the VA during pregnancy and postpartum. Conclusions: These results inform our understanding of VA health care utilization patterns in pregnant Veterans, particularly those with a history of depression, PTSD, and/or anxiety. The strong utilization of VA mental health services during this time emphasizes the importance of optimizing the coordination of care between VA mental health providers and community-provided obstetric care to enhance outcomes for both mother and child.

Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders

Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities. Design: Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models. Setting: VA healthcare facilities. Participants: 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period. Interventions: We assessed VA healthcare utilization before and after ACA implementation. Outcome Measures: Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions. Results: The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001). Conclusion: Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.

External Determinants of Veterans' Utilization of VA Health Care.

Veterans' utilization of Veterans Affairs (VA) health care is likely influenced by community factors external to the VA, including Medicaid eligibility and unemployment, although such factors are rarely considered in models predicting such utilization. We measured the sensitivity of VA utilization to changes in such community factors (hereafter, "external determinants"), including the 2014 Medicaid expansion following the Affordable Care Act. We merged VA health care enrollment and utilization data with area-level data on Medicaid policy, unemployment, employer-sponsored insurance, housing prices, and non-VA physician availability (2008-2014). For veterans aged 18-64 and ≥65, we estimated the sensitivity of annual individual VA health care utilization, measured by the cost ($) of care received, to changes in external determinants using longitudinal regression models controlling for individual fixed effects. All external determinants were associated with small but significant changes in VA health care utilization. In states that expanded Medicaid in 2014, this expansion was associated with 9.1 percent ($826 million) reduction in VA utilization among those aged 18-64; sizable changes occurred in all services used (inpatient, outpatient, and prescription drugs). Changes in alternative insurance coverage and other external determinants may affect VA health care spending. Policy makers should consider these factors in allocating VA resources to meet local demand.

Traumatic brain injury among women veterans: an invisible wound of intimate partner violence.

Intimate partner violence (IPV) is prevalent among women Veterans and is known to increase women's risk for traumatic brain injury (TBI). IPV-related TBI has not been examined in the women Veteran population. To identify the occurrence of IPV-related TBI in a sample of women Veterans and examine the associations of IPV-related TBI with sociodemographic characteristics, health symptoms, health care utilization, and IPV experiences. Cross-sectional mail survey conducted in 2013. The sample comprised 176 New England Department of Veterans Affairs (VA) women Veteran patients. Self-reported IPV-related TBI was assessed with a modified VA TBI screening tool. The survey included validated measures of depression (Center for Epidemiologic Studies Depression Scale) and posttraumatic stress disorder (PTSD; Posttraumatic Disorder Checklist) symptoms, as well as overall mental and physical health (SF-12), and IPV (Conflict Tactics Scales-Revised-2). Questions assessed past-year VA and non-VA health care use. A total of 18.8% (n=33) met screening criteria for IPV-related TBI history. Women who experienced IPV-related TBI reported significantly higher depression (mean Center for Epidemiologic Studies Depression Scale scores: 26.6 vs. 20.7, P<0.0001) and PTSD (mean Posttraumatic Disorder Checklist scores: 53.2 vs. 34.1, P<0.0001) symptoms, and poorer perceptions of physical health (mean SF-12 34.6 vs. 42.3, P<0.01) than women who experienced IPV to the head without TBI. IPV-related TBI was also associated with poorer perceptions of mental health, as well as more frequent VA health care utilization and overall IPV. IPV-related TBI is associated with poorer mental and physical health in women Veterans. This invisible injury is associated with greater VA health care utilization and IPV exposure. Implications for VA practice and policy are discussed.

Transforming Nursing Practice for Veterans: Personalized, Proactive, and Patient-Driven Healthcare

Veterans Affairs (VA) nursing is a dynamic, diverse group of honored, respected, and compassionate professionals. VA is the leader in the creation of an organizational culture where excellence in nursing is valued as essential for quality healthcare to those who served America. The Veterans Health Administration (VHA) Office of Nursing Services (ONS) serves as a consultant advising on issues of workforce and leadership, academics, research, and evidence-based clinical practice for a workforce of 84,000 nurses nationwide in 152 VA medical centers and healthcare systems. ONS consults with VA nurses to address the needs of Veterans; there are approximately 22.2 million Veterans, 2.5 million of whom are returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Veterans. VA facilities currently deliver healthcare to 8.57 million Veterans. 1 Department of Veterans Affairs VA Health Care Utilization by Recent Veterans. Updated January 20, 2013. http://www.publichealth.va.gov/epidemiology/reports/oefoifond/health-care-utilization/ Google Scholar Veterans Affairs (VA) nursing is a dynamic, diverse group of honored, respected, and compassionate professionals. VA is the leader in the creation of an organizational culture where excellence in nursing is valued as essential for quality healthcare to those who served America. The Veterans Health Administration (VHA) Office of Nursing Services (ONS) serves as a consultant advising on issues of workforce and leadership, academics, research, and evidence-based clinical practice for a workforce of 84,000 nurses nationwide in 152 VA medical centers and healthcare systems. ONS consults with VA nurses to address the needs of Veterans; there are approximately 22.2 million Veterans, 2.5 million of whom are returning Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) Veterans. VA facilities currently deliver healthcare to 8.57 million Veterans. 1 Department of Veterans Affairs VA Health Care Utilization by Recent Veterans. Updated January 20, 2013. http://www.publichealth.va.gov/epidemiology/reports/oefoifond/health-care-utilization/ Google Scholar

Enhanced Influenza Surveillance using Telephone Triage Data in the VA ESSENCE Biosurveillance System

Telephone triage (TT) is a potential data source for biosurveillance. An analysis of Veterans Affairs (VA) TT and visit data for influenza and influenza-like-illness (ILI) was performed for 2010-2011 and 2011-2012 seasons. There were 7,044 influenza-coded calls, 564 hospitalizations, 1,849 emergency/urgent visits, and 416,613 ILI-coded outpatient visits. Spearman correlation coefficients were calculated for influenza-coded calls with hospitalizations (0.77); emergency/urgent visits (0.85); and ILI-outpatient visits (0.88), respectively. For 2011-2012, TT alerted increased influenza activity before other settings. Peak activity was similar across settings for both seasons. TT correlates well with VA healthcare utilization and may provide earlier alerts of influenza activity.

Characteristics and VA Health Care Utilization of U.S. Veterans Who Completed Suicide in Oregon Between 2000 and 2005

Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57% did not have mental health diagnoses and 58% had not seen mental health professionals. A larger proportion of those who accessed care were VA-enrolled and received service-connected disability benefits. Fifty-five veterans were hospitalized during the year prior to death. Of these, 33% completed suicide within 30 days of a hospitalization. Further development of suicide prevention strategies for veterans in the community, including general medical treatment settings, is indicated.

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Effect of Health-Related Quality of Life on Women and Men’s Veterans Affairs (VA) Health Care Utilization and Mortality

Although women will account for almost 11% of veterans by 2040, we know little about their health and functioning, particularly compared to men. To compare women and men veterans' health-related quality of life (HRQOL) and VA health care utilization and to see if previously described associations between HRQOL, subsequent VA health care utilization, and mortality in male veterans would generalize to women veterans. Prospective cohort study of all veterans who received medical care from an Upper Midwest Veterans Affairs facility between 10/1/96 and 3/31/98 and returned a mailed questionnaire. Women's effective survey response rate was 52% (n = 1,500); men's, 58% (n = 35,000). In the following year, 9% of women and 12% of men had at least one hospitalization. One percent of women and 3% of men died in the post-survey year. After adjustment, women's HRQOL was higher than men's; for every 10-point decrement in overall physical or mental functioning, women and men had similarly increased risk/odds of subsequently dying, being hospitalized at a VA facility, or making a VA outpatient stop. Among younger women and women who received VA care outside of the Twin City metro area, poorer overall mental or physical health functioning was associated with fewer primary care stops; among their male counterparts, it was associated with more primary care stops. Compared to men, women veterans receiving VA health care in the upper Midwest catchment area had better HRQOL and used fewer health services. Although VA health care utilization was similar across gender after adjusting for HRQOL, poorer mental or physical health was associated with fewer primary care stops for selected subgroups of women.