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

• Published in: Journal of general internal medicine : JGIM Vol. 26; no. Suppl 2; pp. 669 - 675
• Main Authors: Ajmera, Mayank, Wilkins, Tricia Lee, Sambamoorthi, Usha
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-11-2011; Springer Nature B.V
• Subjects: Adult; Aged; Ambulatory care; Ambulatory Care - statistics & numerical data; Chi-Square Distribution; Cross-Sectional Studies; Female; Health Services Research; Hospitalization; Hospitalization - statistics & numerical data; Hospitals, Veterans - statistics & numerical data; Humans; Internal Medicine; Logistic Models; Male; Medicare; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Middle Aged; Original Research; Risk Factors; Surveys and Questionnaires; United States; Veterans; Veterans Health - standards; dual utilization; ACSH; veterans; care coordination
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-011-1788-4

ABSTRACT
OBJECTIVE
The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use.
PARTICIPANTS
A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS).
DESIGN/MEASUREMENTS
Cross-sectional analyses (N = 44,988) of linked fee-for-service Medicare claims and survey data from multiple years of the MCBS (2001–2005). Any ACSH and specific types of ACSH were measured using the list of prevention quality indicators developed by the Agency for Healthcare Research and Quality. Among veterans, dual Medicare/VHA use was defined as having inpatient or outpatient visits paid by VHA and consisted of three categories: 1) predominant-VHA use; 2) some VHA use and no VHA use. Unadjusted group differences in any ACSH were tested using chi-square tests. Logistic regressions were used to analyze the association between dual Medicare/VHA use and ACSH after controlling for demographic, socio-economic status, health status, functional status, smoking status and obesity. All analyses accounted for the complex design of the MCBS.
RESULTS
Among inpatient users, 10.1% had ACSH events for acute conditions and 15.8% for chronic conditions. Among all survey respondents, 5% had any ACSH event. Among predominant-VHA users the rate was 4.9% and among veterans with some VHA use it was 3.7%. In bivariate and multivariate analyses, dual Medicare/VHA use was not significantly associated with any ACSH.
CONCLUSION
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.