Do Veterans Health Administration Enrollees Generalize to Other Populations?

Abstract

The Veterans Health Administration (VHA) has historically served a disproportionately male patient population with lower income and greater rates of mental illness than non-VHA populations. The generalizability of research based on VHA enrollees is unknown because the overlap between VHA and non-VHA populations has never been empirically examined. This study used 2013 National Health Interview Survey data to examine the extent to which VHA enrollees had similar demographic and health characteristics as individuals with Medicaid, Medicare, or private insurance coverage, based on propensity score models. A majority of male VHA enrollees were similar to Medicare beneficiaries suggesting greater generalizability of VHA studies than commonly hypothesized. Overlap declined when comparing with Medicaid enrollees or privately insured individuals, suggesting more limited generalizability of VHA studies to these populations.

Contribution of patient, physician, and environmental factors to demographic and health variation in colonoscopy follow‐up for abnormal colorectal cancer screening test results

“…Finally, the VHA population is unique and may not generalize to other settings. However, as the largest integrated health care system in the United States, the VHA population does generalize to a substantial number of individuals, including non‐VHA Medicare beneficiary populations …”

Sleep Disturbance Among HIV-Infected and Uninfected Veterans

“…These results suggest that research done within the VHA may be generalizable to other clinical populations. 15 …”

Rates of clinically significant prostate cancer in African Americans increased significantly following the 2012 US Preventative Services Task Force recommendation against prostate specific antigen screening: A Single Institution Retrospective Study

“…However, propensity score models have demonstrated significant overlap between VHA and Medicare beneficiaries in regard to patient demographics, health service utilisation, health status, and medical expenditures 13. The most significant finding of the present study is that, in the 6 years following the 2012 USPSTF D recommendation against PSA screening, detection rates of intermediate-high grade disease remained unchanged for Caucasians but have increased significantly for African Americans.…”

“…we sought to evaluate the impact of the 2012 USPSTF guideline recommendation on prostate cancer detection rates and biopsy patterns in African American patients and Caucasian patients at a single Veterans Affairs Hospital in New York City. Although potential confounding factors associated with military service remain an important consideration with respect to the generalisability of the present study, VHA studies are indeed more generalisable than is commonly hypothesised 13. One potential explanation for the increased detection rate of intermediate-high grade disease among African American patients is that more conservative screening measures has reduced the number of cases identified in the early course of disease and these patients are now being diagnosed at a more advanced stage.…”