Pharmacy use by dual-eligible non-elderly veterans with private healthcare insurance.

Background: Utilization of private sector healthcare services among dual enrolled veterans with private healthcare insurance plans (PHIP) has not been well-characterized. Concurrent use of Veterans Health Administration (VHA) and non-VHA pharmacies may increase risk for adverse outcomes. Thus, the objectives of this study were to determine the extent to which dual VHA-PHIP enrollees obtain medications through VHA and non-VHA pharmacies and to characterize medications obtained through non-VHA pharmacies.

Veteran Use of Health Care Systems in Rural States: Comparing VA and Non-VA Health Care Use Among Privately Insured Veterans Under Age 65.

Objective: To quantify use of VA and non-VA care among working-age veterans with private insurance by linking VA data to private health insurance plan (PHIP) data.

Methods: Demographics and utilization were compared between dual users of VA and non-VA systems versus single-system users for veterans < 65 living in 2 rural Midwestern states concurrently enrolled in VA health care and a PHIP for ≥ 1 complete federal fiscal year from 2000 to 2010. Chi-square and t-tests were used for univariate analyses.

Insured Veterans' Use of VA and Non-VA Health Care in a Rural State.

Purpose: To understand how working-age VA-enrolled veterans with commercial insurance use both VA and non-VA outpatient care, and how rural residence affects dual use, for common diagnoses and procedures.

Methods: We analyzed VA and non-VA outpatient treatment records for any months during 2005-2010 that New Hampshire veterans ages <65 were simultaneously enrolled in VA health care and commercial insurance (per NH's mandatory claims database). Controlling for covariates, we used analysis of variance to compare urban and rural VA users, non-VA users, and dual users on travel burden, diagnosis counts, duration in outpatient care, and visit frequencies, and logistic regressions to assess whether rural veterans were as likely to be seen for common conditions and procedures.

Differences Among States in Rural Veterans' Use of VHA and Non-VHA Hospitals.

Purpose: To understand how vouchers for non-VHA care of VHA-enrolled veterans might affect rural enrollees, we determined how much enrollees use VHA and non-VHA inpatient care, and whether this use varies substantially between rural and urban residents depending on state of residence.

Methods: For veterans listed in the 2007 VHA enrollment file as living in Arizona, Iowa, Louisiana, Tennessee, Florida, South Carolina, Pennsylvania, or New York, we merged 2004-2007 administrative discharge data for all VHA hospitalizations with all non-VHA hospitalizations listed in state health department or hospital association databases. Within states, rural and urban residents (RUCA-defined) were compared on VHA and non-VHA hospitalization rates, overall and for major diagnostic categories.

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

Background: Veterans 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.

Method: For 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.

Associations between childbirth and women veterans' VA and non-VA Hospitalizations for major diagnostic categories.

Women Veterans enrolled in Veterans Affairs (VA) health care almost always use non-VA hospitals for childbirth, making it more likely they will use non-VA hospitals for other needs, as well. We compared VA and non-VA hospitalizations obtained by VA enrollees in seven states from 2004 through 2007 to determine whether women aged 18 to 44 were more likely to use VA or non-VA care for diagnoses in certain major categories, and how this use differed between women who did or did not have any pregnancy/childbirth admissions during the 4 years. We found that women were hospitalized much more in non-VA than in VA hospitals, though they were relatively more likely to use VA hospitals for mental illness, digestive system diseases, and neoplasms than other diagnoses.

Use and Quality of Care at a VA Outreach Clinic in Northern Maine.

Objective: To assess use and quality of care at a new 1-day-per-week Veterans Administration Outreach Clinic in remote northern Maine.

Methods: Veterans Administration electronic medical records were abstracted to compare outreach clinic patients seen in its first year to patients seen at the nearest outpatient treatment sites, a small-staff, full-time VA clinic 81 miles away and a community-based outpatient clinic 55 miles away. Chart abstractions (N = 1251) yielded counts of visits, patients newly enrolled in VA care, patients transferring to the outreach clinic, and patients who had and maintained a local non-VA primary care physician, as well as multiple quality of care performance measures using standard VA criteria.

Health behaviors and utilization among users of complementary and alternative medicine for treatment versus health promotion.

Objective: To compare the characteristics, health behaviors, and health services utilization of U.S. adults who use complementary and alternative medicine (CAM) to treat illness to those who use CAM for health promotion.

Defining "rural" for veterans' health care planning.

Purpose: The Veterans Health Administration (VHA) devised an algorithm to classify veterans as Urban, Rural, or Highly Rural residents. To understand the policy implications of the VHA scheme, we compared its categories to 3 Office of Management and Budget (OMB) and 4 Rural-Urban Commuting Area (RUCA) geographical categories.

Method: Using residence information for VHA health care enrollees, we compared urban-rural classifications under the VHA, OMB, and RUCA schemes; the distributions of rural enrollees across VHA health care networks (Veterans Integrated Service Networks [VISNs]); and how each scheme indicates whether VHA standards for travel time to care are met for the most rural veterans.

A longitudinal analysis of rural and urban veterans' health-related quality of life.

Context: Cross-sectional studies have identified rural-urban disparities in veterans' health-related quality-of-life (HRQOL) scores.

Purpose: To determine whether longitudinal analyses confirmed that these disparities in veterans' HRQOL scores persisted.

Methods: We obtained data from the SF-12 portion of the veterans health administration's (VA's) Survey of Healthcare Experiences of Patients (SHEP) collected between 2002 and 2006.

Practical and policy implications of using different rural-urban classification systems: a case study of inpatient service utilization among Veterans Administration users.

Context: Several classification systems exist for defining rural areas, which may lead to different interpretations of rural health services data.

Purpose: To compare rural classification systems on their implications for estimating Veterans Administration (VA) utilization.

Methods: Using 7 classification systems, we counted VA health care enrollees who lived in each category, and number admitted to VA hospitals or non-VA hospitals under Medicare.

Health care expenditures for urban and rural veterans in Veterans Health Administration care.

Objective: To compare Veterans Health Administration (VA) patients, non-VA-using veterans, and nonveterans, separated by urban/rural residence and age group, on their use of major categories of medical care and payment sources.

Data Source: Expenditures for health care-using men in Medical Expenditure Panel Surveys from 1996 through 2004.

Study Design: Retrospective, cross-sectional analysis.

Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals?

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality.

Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts.

Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004.

Research on rural veterans: an analysis of the literature.

Context: The Veterans Health Administration (VA) provides comprehensive health care services to veterans across the United States. Recently, the VA established an Office of Rural Health to address the health care needs of rural veterans.

Purpose: To review the literature on rural veterans' health care needs in order to identify areas for future research.

Rural veterans and access to high-quality care for high-risk surgeries.

Objectives: To determine whether older Veterans Health Administration (VA) health care enrollees obtain most high-risk surgeries in non-VA hospitals under Medicare, whether residence in less populous areas increases this reliance on non-VA care or the likelihood of obtaining it in hospitals with higher mortality rates, and whether directing VA enrollees to better hospitals would add a substantial travel burden.

Data Sources: VA and Medicare hospital discharge data from 2000 and 2001 for VA enrollees 65 years or older who received any of 14 high-risk elective procedures, including heart, vascular, and cancer surgeries. STUDY DESIGN/DATA EXTRACTION: We compared urban, suburban, and rural patients on use of VA versus non-VA hospitals, use of non-VA hospitals of higher versus lower mortality rates, travel times to get to these hospitals, and the additional travel burden if they had gone to lower mortality hospitals.

When VA patients have non-VA hospitalizations, who pays for what services, and what are the research implications? A New York case study.

Objective: To determine, for Veterans Health Administration (VA) enrollees who lived and were hospitalized in New York State between 1998 and 2000, the primary payers for their non-VA admissions, whether the primary payer mix varied by condition treated, and whether the Medicare claims data that VA acquired on its Medicare-enrolled patients captured all or most of their non-VA inpatient care.

Methods: Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 75,046 residents of New York State who were enrolled in the VA and had 159,843 inpatient admissions in New York hospitals not in the VA system. For each admission, we determined the major diagnostic category, the primary payer for the admission, and whether the patient was Medicare-enrolled.

Comparing the characteristics, utilization, efficiency, and outcomes of VA and non-VA inpatient care provided to VA enrollees: a case study in New York.

Objective: To compare the characteristics, utilization, and outcomes of Veterans Health Administration (VA) and non-VA inpatient care provided to VA enrollees in New York.

Methods: Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 110,716 residents of New York State who were enrolled in the VA and had 266,869 inpatient admissions in VA and non-VA hospitals in New York. For each admission, we determined the system of care used (VA or non-VA), patient demographics, and characteristics of the admission, and we calculated VA patients' relative reliance on the VA for inpatient care.

Rare adverse medical events in VA inpatient care: reliability limits to using patient safety indicators as performance measures.

Objective: To assess Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) as performance measures using Veterans Administration hospitalization data. DATA SOURCES STUDY SETTING: Nine years (1997-2005) of all Veterans Health Administration (VA) administrative hospital discharge data.

Study Design: Retrospective analysis using diagnoses and procedures to derive annual rates and standard errors for 13 PSIs.

Where do veterans health administration patients obtain heart, liver, and kidney transplants?

We sought to determine whether Veterans Health Administration (VA) enrollees use the VA system or the private sector for solid-organ transplantation and whether VA system use is associated with patients' proximity to a VA transplant center. Using a national VA/Medicare inpatient data set and a comprehensive New York State VA/private-sector inpatient data set for 1998 to 2000, we found that veterans enrolled in the VA system obtained approximately one-half of their liver transplants, but few heart and kidney transplants, in the VA system. Patients were much more likely to use the VA system if they lived in a VA service area that offered relevant transplant services.

Reducing avoidable deaths among veterans: directing private-sector surgical care to high-performance hospitals.

Objectives: We quantified older (65 years and older) Veterans Health Administration (VHA) patients' use of the private sector to obtain 14 surgical procedures and assessed the potential impact of directing that care to high-performance hospitals.

Methods: Using a merged VHA-Medicare inpatient database for 2000 and 2001, we determined where older VHA enrollees obtained 6 cardiovascular surgeries and 8 cancer resections and whether private-sector care was obtained in high- or low-performance hospitals (based on historical performance and determined 2 years in advance of the service year). We then modeled the mortality and travel burden effect of directing private-sector care to high-performance hospitals.

Who pays when VA users are hospitalized in the private sector? Evidence from three data sources.

Background: Older veterans enrolled in VA healthcare receive much of their medical care in the private sector, through Medicare. Less is known about younger VA enrollees' use of the private sector, or its funding. We compare payers for younger and older enrollees' private sector use in 3 hospitalization datasets.

Unintended consequences of regionalizing specialized VA addiction services.

Objective: From 1995 to 2000 the Department of Veterans Affairs (VA) dramatically reduced addiction treatment funding and regionalized specialized services to urban centers. By using New York State as an example, this study examined whether regionalization disproportionately affected rural versus urban veterans' use of VA and non-VA inpatient addiction services.

Methods: By using a comprehensive data set of VA and non-VA hospitalizations for 294,748 VA enrollees who were residents of New York State from 1998 to 2000, this study examined admission rates for addiction treatment to VA and non-VA centers to determine how rates differed between rural veterans and urban veterans.

Mental distress among younger veterans before, during, and after the invasion of Iraq.

Objective: The purpose of this study was to determine whether patients receiving care from the Department of Veterans Affairs (VA) reported more mental distress as the war in Iraq began or reintensified compared with other respondents to national health surveys.

Methods: Data from the 2000 and 2003 Behavioral Risk Factor Surveillance System (BRFSS) health surveys were analyzed. Unlike in other years, these particular surveys asked respondents whether they were military veterans.