Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team.
Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team.
复制标题
加入退伍军人管理局无家可归患者协调护理团队的退伍军人的双重用途和入院。
DOI：
10.1111/1475-6773.13034
复制
发表时间：
2018
影响因子：
3.4
通讯作者：
O'Toole,ThomasP
中科院分区：
文献类型：
--
作者：
Trivedi,AmalN;Jiang,Lan;Johnson,ErinE;Lima,JulieC;Flores,Michael;O'Toole,ThomasP
目的研究无家可归患者联盟护理团队（Homeless Patient Aligned Care Team，H-PACT）招募的符合医疗保险条件的退伍军人对退伍军人门诊护理的依赖与住院之间的关联。数据来源/研究设置与退伍军人和医疗保险利用数据相关的H-PACT招募者登记处2013年研究设计根据退伍军人是否接受了> 90%的门诊护理将退伍军人分配到两组后（较高的依赖）或<90%的VA门诊护理（低依赖），广义线性模型与治疗权重的逆概率被用来估计与医疗保险和VA资助的住院率的依赖的关联。主要发现与高依赖退伍军人相比，低依赖退伍军人有相同数量的年度VA住院（0.63 vs. 0.50;p= 0.14），但医疗保险住院率显著增加（0.85 vs. 0.08;p<0.001）。在门诊就诊率最高的退伍军人中，我们观察到VA医院使用率在统计学上相似，但医疗保险资助的住院率高出10倍以上（低依赖为1.31，高依赖为0.15; p< .001）。结论在VA的H-PACT中接受综合护理的退伍军人中，医疗保险和退伍军人管理局门诊护理的双重使用与医疗保险资助的急性住院密切相关。将VA和非VA数据联系起来可以识别出一部分无家可归的退伍军人，他们的门诊护理分散，结果不佳的风险增加。
ObjectiveTo examine the association between reliance on VA outpatient care and hospital admissions among Medicare‐eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H‐PACT).Data Sources/Study SettingRegistry of H‐PACT enrollees linked to VA and Medicare utilization data for 2013.Study DesignAfter assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA‐financed hospital admissions.Principal FindingsCompared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual VA hospitalizations (0.63 vs. 0.50;p= .14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08;p< .001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of VA hospital use but over 10‐fold greater rates of Medicare‐financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance;p< .001).ConclusionsAmong Veterans receiving integrated care in VA's H‐PACT, dual use of Medicare and VA outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking VA and non‐VA data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.