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Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services

BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality. METHODS: Our secondary analysis used survey, claims, and Nation...

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Autores principales: Wolinsky, Fredric D, An, Hyonggin, Liu, Li, Miller, Thomas R, Rosenthal, Gary E
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884152/
https://www.ncbi.nlm.nih.gov/pubmed/17490488
http://dx.doi.org/10.1186/1472-6963-7-70
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author Wolinsky, Fredric D
An, Hyonggin
Liu, Li
Miller, Thomas R
Rosenthal, Gary E
author_facet Wolinsky, Fredric D
An, Hyonggin
Liu, Li
Miller, Thomas R
Rosenthal, Gary E
author_sort Wolinsky, Fredric D
collection PubMed
description BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality. METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used. RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02). CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered.
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spelling pubmed-18841522007-05-30 Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services Wolinsky, Fredric D An, Hyonggin Liu, Li Miller, Thomas R Rosenthal, Gary E BMC Health Serv Res Research Article BACKGROUND: Older veterans may use both the Veterans Health Administration (VHA) and Medicare, but the association of dual use with health outcomes is unclear. We examined the association of indirect measures of dual use with mortality. METHODS: Our secondary analysis used survey, claims, and National Death Index data from the Survey on Assets and Health Dynamics among the Oldest Old. The analytic sample included 1,521 men who were Medicare beneficiaries. Veterans were classified as dual users when their self-reported number of hospital episodes or physician visits exceeded that in their Medicare claims. Veterans reporting inpatient or outpatient visits but having no Medicare claims were classified as VHA-only users. Proportional hazards regression was used. RESULTS: 897 (59%) of the men were veterans, of whom 134 (15%) were dual users. Among dual users, 60 (45%) met the criterion based on inpatient services, 54 (40%) based on outpatient services, and 20 (15%) based on both. 766 men (50%) died. Adjusting for covariates, the independent effect of any dual use was a 38% increased mortality risk (AHR = 1.38; p = .02). Dual use based on outpatient services marginally increased mortality risk by 45% (AHR = 1.45; p = .06), and dual use based on both inpatient and outpatient services increased the risk by 98% (AHR = 1.98; p = .02). CONCLUSION: Indirect measures of dual use were associated with increased mortality risk. New strategies to better coordinate care, such as shared medical records, should be considered. BioMed Central 2007-05-09 /pmc/articles/PMC1884152/ /pubmed/17490488 http://dx.doi.org/10.1186/1472-6963-7-70 Text en Copyright © 2007 Wolinsky et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Wolinsky, Fredric D
An, Hyonggin
Liu, Li
Miller, Thomas R
Rosenthal, Gary E
Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title_full Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title_fullStr Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title_full_unstemmed Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title_short Exploring the association of dual use of the VHA and Medicare with mortality: separating the contributions of inpatient and outpatient services
title_sort exploring the association of dual use of the vha and medicare with mortality: separating the contributions of inpatient and outpatient services
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1884152/
https://www.ncbi.nlm.nih.gov/pubmed/17490488
http://dx.doi.org/10.1186/1472-6963-7-70
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