Journal article
Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?
BMC health services research, Vol.6(1), pp.131-131
10/09/2006
DOI: 10.1186/1472-6963-6-131
PMCID: PMC1617101
PMID: 17029643
Abstract
Background
Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.
Methods
Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.
Results
96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).
Conclusion
An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.
Details
- Title: Subtitle
- Dual use of Medicare and the Veterans Health Administration: are there adverse health outcomes?
- Creators
- Fredric D Wolinsky - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USAThomas R Miller - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USAHyonggin An - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USAPaul R Brezinski - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USAThomas E Vaughn - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USAGary E Rosenthal - Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA Health Management and Policy, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Internal Medicine, Carver College of Medicine, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA Biostatistics, College of Public Health, the University of Iowa, 200 Hawkins Drive, Iowa City, IA52242, USA United States Air Force, USA
- Resource Type
- Journal article
- Publication Details
- BMC health services research, Vol.6(1), pp.131-131
- DOI
- 10.1186/1472-6963-6-131
- PMID
- 17029643
- PMCID
- PMC1617101
- NLM abbreviation
- BMC Health Serv Res
- ISSN
- 1472-6963
- eISSN
- 1472-6963
- Publisher
- BioMed Central
- Language
- English
- Date published
- 10/09/2006
- Academic Unit
- Health Management and Policy; Nursing; Internal Medicine
- Record Identifier
- 9984214818902771
Metrics
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