Dual Medicare and Veteran Health Administration Use and Ambulatory Care Sensitive Hospitalizations

Abstract

In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.

AHRQ Prevention Quality Indicators to assess the quality of primary care of local providers: a pilot study from Italy

“…Interestingly, while the admission rates for preventable conditions declined by 2.4% during the study period (À7.4% among chronic conditions and +12.2% among acute conditions), the rates for nonpreventable conditions (all the others 41 ) declined by 7.3%, which does not seem to indicate an impact on primary health care-at least in the short-term and especially for acute conditions-of the concomitant in-depth Italian health care system restructuring 42 (which were only recently focused on primary care organization 43 ). PQIs have already been validated to assess primary health care quality in several studies carried out in the USA [19][20][21][22][23][24][25][26][27][28][29]44 and other countries, 45 including Italy. [32][33][34][35] The comparisons, however, were carried out mostly at a national [19][20][21][22][23][24][25]44 or regional level 34,35 or to identify potential predictors of poorer access to primary health care.…”

“…PQIs have already been validated to assess primary health care quality in several studies carried out in the USA [19][20][21][22][23][24][25][26][27][28][29]44 and other countries, 45 including Italy. [32][33][34][35] The comparisons, however, were carried out mostly at a national [19][20][21][22][23][24][25]44 or regional level 34,35 or to identify potential predictors of poorer access to primary health care. [26][27][28]32,33 Some technical AHRQ reports reported data at a county level, but no attempt at assessing the validity of PQIs was made.…”

“…3,8,9 An important progress was achieved in the early 1990s with the concept of 'potentially avoidable' or 'ambulatory care sensitive' hospitalizations, 10 which were extensively used to indirectly evaluate the performance of primary health care in several countries. [11][12][13][14][15][16] Based on the assumption that the hospitalization for several chronic and acute conditions can be prevented with timely and appropriate ambulatory care, 17 the Agency for Healthcare Research and Quality (AHRQ) developed a set of 14 primary care quality measures, named 'prevention quality indicators' (PQIs), which were first released in 2000 18 and which have been validated in the USA to compare the performance of national [19][20][21][22][23][24][25][26][27][28] and local (counties) [29][30][31] providers. Some of the PQIs were also used in Italy to compare the quality of primary health care across the regions.…”

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge

“…The VA is the largest integrated health care system in the U.S. and provides care for over 5 million patients annually (Kizer and Dudley, 2009). VA patients generally have poorer health status and more comorbidities, including mental health conditions, than non-VA patients (Ajmera et al, 2011; Selim et al, 2010). The VA has emerged as a leader in implementation of alcohol screening and other health systems are increasingly implementing alcohol screening as well (Jonas et al, 2012).…”

Reduced Overall and Event-Free Survival among Colon Cancer Patients Using Dual System Care

“…However, relatively little is known about the comparative health outcomes of veterans who receive their care predominantly or entirely in one system-VA or the private sector-and those who receive substantial portions of their care in both systems (10)(11)(12)(13)(14).…”