State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis
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 ra...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2018-02-01
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| Series: | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| Online Access: | https://doi.org/10.1177/0046958018756216 |
| _version_ | 1818115343650914304 |
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| author | Drew A. Helmer MD Mazhgan Rowneki MPH Xue Feng MPH Chin-lin Tseng DrPh Danielle Rose PhD Orysya Soroka MS Dennis Fried PhD Nisha Jani PhD Leonard M. Pogach MD Usha Sambamoorthi PhD |
| author_facet | Drew A. Helmer MD Mazhgan Rowneki MPH Xue Feng MPH Chin-lin Tseng DrPh Danielle Rose PhD Orysya Soroka MS Dennis Fried PhD Nisha Jani PhD Leonard M. Pogach MD Usha Sambamoorthi PhD |
| author_sort | Drew A. Helmer MD |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T04:05:07Z |
| format | Article |
| id | doaj.art-67488ef9dea64148abd0aa65329d3a64 |
| institution | Directory Open Access Journal |
| issn | 0046-9580 1945-7243 |
| language | English |
| last_indexed | 2024-12-11T04:05:07Z |
| publishDate | 2018-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| spelling | doaj.art-67488ef9dea64148abd0aa65329d3a642022-12-22T01:21:32ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432018-02-015510.1177/0046958018756216State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial AnalysisDrew A. Helmer MD0Mazhgan Rowneki MPH1Xue Feng MPH2Chin-lin Tseng DrPh3Danielle Rose PhD4Orysya Soroka MS5Dennis Fried PhD6Nisha Jani PhD7Leonard M. Pogach MD8Usha Sambamoorthi PhD9Rutgers University, New Jersey Medical School, Newark, NJ, USAWar Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USAWest Virginia University, School of Pharmacy, Morgantown, USAWar Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USAVeteran Affairs Greater Los Angeles Healthcare System, Sepulveda, CA, USAWar Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USAWar Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USARutgers University, School of Public Health, Newark, NJ, USAWar Related Illness and Injury Study Center, Veterans Affairs New Jersey Medical Center, East Orange, NJ, USAWest Virginia University, School of Pharmacy, Morgantown, USAMost 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.https://doi.org/10.1177/0046958018756216 |
| spellingShingle | Drew A. Helmer MD Mazhgan Rowneki MPH Xue Feng MPH Chin-lin Tseng DrPh Danielle Rose PhD Orysya Soroka MS Dennis Fried PhD Nisha Jani PhD Leonard M. Pogach MD Usha Sambamoorthi PhD State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis Inquiry: The Journal of Health Care Organization, Provision, and Financing |
| title | State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis |
| title_full | State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis |
| title_fullStr | State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis |
| title_full_unstemmed | State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis |
| title_short | State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis |
| title_sort | state level variability in veteran reliance on veterans health administration and potentially preventable hospitalizations a geospatial analysis |
| url | https://doi.org/10.1177/0046958018756216 |
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