Reliance on Veterans Affairs Outpatient Care by Medicare-eligible Veterans

Liu, Chuan Fen; Manning, Willard G.; Burgess, James; Hebert, Paul L.; Bryson, Chris L.; Fortney, John C.; Perkins, Mark; Sharp, Nancy; Maciejewski, Matthew L.

doi:10.1097/mlr.0b013e31822396c5

Cited by 78 publications

(106 citation statements)

References 18 publications

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“…Third, patients were excluded from the study sample if they did not have an AUDIT-C score in the year prior to hospitalization. Relative to the study sample, VA patients missing AUDIT-C scores had a lower prevalence of some conditions, such as chronic pulmonary disease, psychosis, AUD, and tobacco use disorders (Supplementary material 10 7 ), consistent with previous studies of VA care (Liu et al, 2011; Petersen et al, 2010). Thus, AUDIT-C scores do not appear to be missing at random and we do not know whether similar associations would be observed between alcohol risk groups and study outcomes had AUDIT-C scores been available for excluded patients.…”

Section: Discussionsupporting

confidence: 85%

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

Chavez

Liu

Tefft

et al. 2016

Drug and Alcohol Dependence

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Background Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. Methods Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009–10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. Results Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n = 7167) and nondrinking (n =357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0–14.6%; and 14.2%, 95% CI 14.1–14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7–13.0%). Only nondrinkers had increased risk for ED visits. Conclusions Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits.

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Section: Discussionsupporting

confidence: 85%

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

Chavez

Liu

Tefft

et al. 2016

Drug and Alcohol Dependence

Self Cite

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“…This is especially true of the Medicare-eligible population, as there is widespread dual use of both VA and Medicare services. 38, 39 However, in analyses restricted to veterans aged younger than 65 years, findings remained consistent. Third, bias could occur if there was differential reporting of CVD events among participants versus non-participants, owing to Medicare eligibility or other factors such as proximity or access to VA services.…”

Section: Discussionmentioning

confidence: 82%

Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program

Jackson

Safo

Staimez

et al. 2017

American Journal of Preventive Medicine

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Introduction Lifestyle change programs implemented within healthcare systems could reach many Americans, but their impact on cardiovascular disease (CVD) remains unclear. The MOVE! program is the largest lifestyle change program implemented in a healthcare setting in the U.S. This study aimed to determine whether MOVE! participation was associated with reduced CVD incidence. Methods This retrospective cohort study, analyzed in 2013–2015, used national Veterans Health Administration databases to identify MOVE! participants and eligible non-participants for comparison (2005–2012). Patients eligible for MOVE!—obese or overweight with a weight-related health condition, and no baseline CVD—were examined (N=1,463,003). Of these, 169,248 (12%) were MOVE! participants. Patients were 92% male, 76% white, with mean age 52 years and BMI of 32. The main outcome was incidence of CVD (ICD-9 and procedure codes for coronary artery disease, cerebrovascular disease, peripheral vascular disease, and heart failure). Results Adjusting for age, race, sex, BMI, statin use, and baseline comorbidities, over a mean 4.9 years of follow-up, MOVE! participation was associated with lower incidence of total CVD (hazard ratio [HR]=0.83, 95% CI=0.80, 0.86), coronary artery disease (HR=0.81, 95% CI=0.77, 0.86), cerebrovascular disease (HR=0.87, 95% CI=0.82, 0.92), peripheral vascular disease (HR=0.89, 95% CI=0.83, 0.94), and heart failure (HR=0.78, 95% CI=0.74, 0.83). The association between MOVE! participation and CVD incidence remained significant when examined across categories of race/ethnicity, BMI, diabetes, hypertension, smoking status, and statin use. Conclusions Although participation was limited, MOVE! was associated with reduced CVD incidence in a nationwide healthcare setting.

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“…Although Veterans may face similar challenges in traveling to care regardless of whether the care is provided by VA or private-sector providers (Wakefield et al, 2007), VA health care providers we interviewed noted that a long distance from a facility or concerns about transportation to the nearest facility may lead Veterans to seek alternative sources of health care. Studies of female, Medicare-eligible, and rural Veterans support this view, finding that these Veterans are less likely to seek or continue to seek care from VA if they live farther away from VA facilities (Petersen et al, 2010;Buzza et al, 2011;Liu et al, 2011;Hamilton et al, 2013;Nayar et al, 2013;Friedman et al, 2015). Similarly, Overview of Methods and Data for Access to VA Care…”

Section: Effects Of Geographic Factors On Enrollment In Va Use Of Vamentioning

confidence: 98%

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

Hussey¹,

Ringel²,

Ahluwalia³

et al. 2015

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Reliance on Veterans Affairs Outpatient Care by Medicare-eligible Veterans

Abstract: Reliance on VA primary and specialty care among VA primary care patients decreased substantially over time, particularly for specialty care. Increasing use of non-VA services may complicate VA's implementation of patient-centered medical home models and performance measurement.

Cited by 78 publications

References 18 publications

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

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

Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

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