Medicare‐VHA dual use is associated with poorer chronic wound healing

Bouldin, Erin D.; Littman, Alyson J.; Wong, Edwin S.; Liu, Chuan Fen; Taylor, Larry E.; Rice, Kenneth; Reiber, Gayle E.

doi:10.1111/wrr.12454

Cited by 2 publications

(1 citation statement)

References 38 publications

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“…As noted above, we found poorer wound outcomes for dual users compared to VHA-exclusive users in this sample [25], similar to Helmer et al [12]. However, other studies have shown no association between dual use and other health outcomes [26].…”

Section: Discussionsupporting

confidence: 88%

Chronic wound care utilization among Veterans using VHA and Medicare

et al. 2017

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Veterans who use the Veterans Health Administration (VHA) also may use Medicare coverage for treatment outside VHA. Using multiple health care systems introduces fragmentation and may increase utilization. The purpose of this study was to compare chronic wound care utilization among VHA-Medicare dual system users and VHA-exclusive users. Using data from VHA chart review and Medicare claims, we conducted a retrospective cohort study of 203 Medicare-enrolled VHA users with an incident, chronic lower limb wound between October 1, 2006 and September 30, 2007 and followed them for up to one year. We identified all VHA and Medicare wound-care visits during the wound episode. 19.7% of the cohort was dual users. Dual users had higher observed wound care utilization than VHA-exclusive users (11.9 versus 7.6 outpatient visits [p = 0.002] and 1.6 versus 0.7 inpatient stays [p = 0.0008]). After adjusting for covariates including wound duration, dual users were predicted to have 8.6 outpatient wound care visits and 1.1 inpatient wound care stays while VHA-exclusive users were predicted to have 7.0 (p = 0.07) outpatient visits and 0.7 (p = 0.05) inpatient stays. In conclusion, dual use contributes to higher wound care utilization potentially because of longer wound duration. Bouldin ED, Abstract BackgroundVeterans who use the Veterans Health Administration (VHA) also may use Medicare coverage for treatment outside VHA. Using multiple health care systems introduces fragmentation and may increase utilization. The purpose of this study was to compare chronic wound care utilization among VHA-Medicare dual system users and VHA-exclusive users. MethodsUsing data from VHA chart review and Medicare claims, we conducted a retrospective cohort study of 203 Medicare-enrolled VHA users with an incident, chronic lower limb wound between October 1, 2006 and September 30, 2007 and followed them for up to one year. We identified all VHA and Medicare wound-care visits during the wound episode. Results 19.7% of the cohort was dual users. Dual users had higher observed wound care utilization than VHA-exclusive users (11.9 versus 7.6 outpatient visits [p = 0.002] and 1.6 versus 0.7 inpatient stays [p = 0.0008]). After adjusting for covariates including wound duration, dual users were predicted to have 8.6 outpatient wound care visits and 1.1 inpatient wound care stays while VHA-exclusive users were predicted to have 7.0 (p = 0.07) outpatient visits and 0.7 (p = 0.05) inpatient stays. ConclusionsDual use contributes to higher wound care utilization potentially because of longer wound duration.

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Section: Discussionsupporting

confidence: 88%

Chronic wound care utilization among Veterans using VHA and Medicare

et al. 2017

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Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

Axon

Gebregziabher

Everett

et al. 2018

JAHA

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BackgroundIndividuals receiving cross‐system care (dual users) have higher rates of healthcare utilization and worse outcomes for heart failure (HF) and other conditions. Individuals can be dual users or single‐system users at different times, though, and little is known about utilization and mortality within discrete episodes of care.Methods and ResultsA retrospective cohort of 3439 patients with 5231 discrete episodes of HF exacerbation were identified between 2007 and 2011. Episodes encompassed the period from 2 weeks before an initial HF emergency department (ED) visit or hospitalization, included any acute care visits within 30 days after initial visit, and ended 30 days after the last acute care visit in the episode chain. All‐cause and HF‐specific ED visits and hospitalization within 30 days of index visit were analyzed using generalized estimating equations with robust variance. Hazard for death within episodes of acute illness was analyzed using Cox proportional hazards models. In adjusted analyses, dual use acute HF episodes were associated with higher odds of all‐cause ED visits (odds ratio 1.61, 95% confidence interval [CI], 1.33, 1.95), HF‐specific ED visits, (odds ratio 1.54, 95% CI, 1.12, 2.13), all‐cause hospitalization (odds ratio 1.89, 95% CI, 1.50, 2.38), and HF‐specific hospitalization (odds ratio 1.62, 95% CI, 1.15–2.30) as compared with Veterans Health Administration–only episodes of acute HF care. Dual use episodes of care were associated with higher hazard for mortality (hazard ratio=1.52, 95% CI 1.07, 2.16) as compared with all–Veterans Health Administration episodes of care.ConclusionsEpisodes of acute HF care spanning across healthcare systems appear to be associated with higher risk of subsequent ED visits, hospitalization, and mortality.

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Medicare‐VHA dual use is associated with poorer chronic wound healing

Cited by 2 publications

References 38 publications

Chronic wound care utilization among Veterans using VHA and Medicare

Chronic wound care utilization among Veterans using VHA and Medicare

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

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