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Helmer DA, Rowneki M, Feng X, Tseng CL, Rose D, Soroka O, Fried D, Jani N, Pogach LM, Sambamoorthi U. State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis. Inquiry 2018; 55:46958018756216. [PMID: 29490533 PMCID: PMC5846924 DOI: 10.1177/0046958018756216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most Veterans who use the Veterans Health Administration (VHA) also utilize private-sector health care providers. To better inform local and regional health care planning, we assessed the association between reliance on VHA ambulatory care and total and system-specific preventable hospitalization rates (PHRs) at the state level. We conducted a retrospective dynamic cohort study using Veterans with diabetes mellitus, aged 66 years or older, and dually enrolled in VHA and Medicare parts A and B from 2004 to 2010. While controlling for median age and proportion of males, we measured the association between reliance on VHA ambulatory care and PHRs at the state level using multivariable ordinary least square regression, geographically weighted regression, and generalized additive models. We measured geospatial patterns in PHRs using global Moran’s I and univariate local indicator spatial analysis. Approximately 30% of hospitalized Veterans experienced a preventable hospitalization. Reliance on VHA ambulatory care at the state level ranged from 13.92% to 67.78% and was generally not associated with PHRs. Geospatial analysis consistently identified a cluster of western states with low PHRs from 2006 to 2010. Given the generally low reliance on VHA ambulatory care and lack of association between this reliance and PHRs, policy changes to improve Veterans’ health care outcomes should address private-sector care in addition to VHA care.
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Affiliation(s)
- Drew A Helmer
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA.,2 Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Mazhgan Rowneki
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Xue Feng
- 3 West Virginia University, School of Pharmacy, Morgantown, USA
| | - Chin-Lin Tseng
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Danielle Rose
- 4 Veteran Affairs Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Orysya Soroka
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Dennis Fried
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
| | - Nisha Jani
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA.,5 Rutgers University, School of Public Health, Newark, NJ, USA
| | - Leonard M Pogach
- 1 War Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USA
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