Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

Abstract

Objective To examine the association between reliance on VA outpatient care and hospital admissions among Medicare‐eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H‐PACT). Data Sources/Study Setting Registry of H‐PACT enrollees linked to VA and Medicare utilization data for 2013. Study Design After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA‐financed hospital admissions. Principal Findings Compared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual VA hospitalizations (0.63 vs. 0.50; p = .14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08; p < .001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of VA hospital use but over 10‐fold greater rates of Medicare‐financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance; p < .001). Conclusions Among Veterans receiving integrated care in VA's H‐PACT, dual use of Medicare and VA outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking VA and non‐VA data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.

Primary Care for Homeless Veterans: A Systematic Review of the Homeless Patient Aligned Care Team (HPACT)

“…(24) Trivedi and colleagues observed that Veterans enrollment in HPACTs with significant dual use of Medicare and VA outpatient care was strongly associated with acute hospitalizations financed by Medicare and high fragmentation of care. (25) Other studies showed mixed results. Patel provided an early case study in 2013 at the VA greater Los Angeles Healthcare System of 47 Veterans who were assigned to the West LA HPACT for at least six months without any statistically significant change in acute ED utilization after six months despite significant increases in HPACT visits and SW encounters.…”

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

“…, and Trivedi et al. ). One study focused on health care use in VA and VA community care (Rosen et al.…”

“…Two studies linked Medicare data to examine the impact of the VA's patient aligned care team intervention (Trivedi et al. ; Reddy et al. ).…”

“…The papers in this special issue used a range of non-VA datasets, several presented for the first time in a research application. Medicare data were the most commonly linked data (used in Wang et al 2018;Thorpe et al 2018;Vaughan Sarrazin et al 2018;Trivedi et al 2018;Reddy et al 2018;Nelson et al 2018a, b;Vanneman et al 2018;Liu et al 2018;Chui et al 2018;Hebert et al 2018;Lei et al 2018), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well-established documentation and file structures (Hynes et al 2007). Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018).…”

“…Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018). These papers leveraged the linked data they created to address a range of topics, including VA and non-VA health care use and costs (Wang et al 2018;Vaughan Sarrazin et al 2018;Hebert et al 2018;Vanneman et al 2018;Liu et al 2018;Lei et al 2018), medication use (Thorpe et al 2018;Carlson et al 2018;and Chiu et al 2018), and the impact of homelessness on health care use and costs (Nelson et al 2018, andTrivedi et al 2018). One study focused on health care use in VA and VA community care (Rosen et al 2018).…”