Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community‐Based and Hospital Outpatient Clinics

Health Services Research - Tập 45 Số 5p1 - Trang 1268-1286 - 2010
Chuan‐Fen Liu1,2, Michael K. Chapko1,3, Chris L. Bryson4,3, James Burgess5,6, John C. Fortney7,8,9, Mark Perkins3, NANCY SHARP1,3, Matthew L. Maciejewski10,11
1Department of Health Services, University of Washington, Seattle, WA
2Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, HSR&D, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101
3Northwest Center for Outcomes Research in Older Adults, Department of Veterans Affairs, Seattle, WA
4Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA
5Center for Organization, Leadership & Management Research, Department of Veterans Affairs, Boston, MA
6Department of Health Policy and Management, School of Public Health, Boston University, Boston, MA
7Division of Health Service Research, Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, North Little Rock, AR
8HSR&D Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR
9South Central Mental Health Illness Research and Education and Clinical Center, North Little Rock, AR
10Center for Health Services Research in Primary Care, Department of Veterans Affairs, Durham, NC
11Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC

Tóm tắt

Objective. To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients.Data Sources/Study Setting. VA administrative and Medicare claims data from 2001 to 2004.Study Design. Retrospective cohort study of outpatient service use by 8,964 community‐based and 6,556 hospital‐based VA primary care patients.Principal Findings. A significant proportion of VA patients used Medicare‐reimbursed primary care (>30 percent) and specialty care (>60 percent), but not mental health care (3–4 percent). Community‐based patients had 17 percent fewer VA primary care visits (p<.001), 9 percent more Medicare‐reimbursed visits (p<.001), and 6 percent fewer total visits (p<.05) than hospital‐based patients. Community‐based patients had 22 percent fewer VA specialty care visits (p<.0001) and 21 percent more Medicare‐reimbursed specialty care visits (p<.0001) than hospital‐based patients, but no difference in total visits (p=.80).Conclusions. Medicare‐eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community‐based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non‐VA providers and health care systems is essential to improve the quality and continuity of care.

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Health Services Research

Tập 45 Số 5p1

1268-1286

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