VA and Medicare Utilization Among Dually Enrolled Veterans with Type 2 Diabetes: A Latent Class Analysis
VA and Medicare Utilization Among Dually Enrolled Veterans with Type 2 Diabetes: A Latent Class Analysis
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DOI：
10.1007/s11606-016-3631-4
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发表时间：
2016-05-01
影响因子：
5.7
通讯作者：
Gellad, Walid F.
中科院分区：
文献类型：
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作者：
Radomski, Thomas R.;Zhao, Xinhua;Gellad, Walid F.
许多在退伍军人医疗系统(VA)内接受治疗的退伍军人也参加了按服务收费(FFS)的医疗保险，并在VA外接受治疗。以前的研究没有考虑到退伍军人在整个医疗系统中接受服务的多种方式。我们的目标是在二次登记的2型糖尿病退伍军人中建立退伍军人退伍军人和医疗保险利用的类型学。这是一个回溯性队列。316,775名居住在社区的退伍军人在2008-2009年双重参加退伍军人保险和FFS医疗保险，他们的年龄为每千日元65岁，他们同时参加了退伍军人和FFS医疗保险。使用潜在类别分析，我们根据退伍军人使用退伍军人退伍军人和联邦医疗保险糖尿病护理服务的概率来确定类别，包括就诊、实验室测试、血糖测试试纸和药物。我们使用多项式回归比较了不同类别之间的医疗使用量，并确定了与类别成员相关的因素。我们确定了四个不同的潜在类别：类别1(53.9%)使用VA的概率较高，而使用医疗保险的概率较低；类别2(17.2%)、类别3(21.8%)和类别4(7.0%)使用VA和联邦医疗保险的概率较高，但使用的医疗保险服务不同。例如，3级的退伍军人只通过联邦医疗保险获得试纸，而4级的退伍军人则依赖联邦医疗保险提供药物。居住在距离退伍军人管理局40英里处的退伍军人管理局预计会员人数为3级(OR 1.1，CI 1.06-1.15)和4级(OR 1.11，CI 1.04-1.18)，而医疗补助资格预测会员资格为4级(OR 4.30，CI 4.10-4.51)。患有糖尿病的退伍军人可以分为四个不同的双重医疗系统使用类别，这代表了一种新的方式来表征患者如何在医疗系统中使用多种服务。这种分类适用于识别面临不同风险的患者，而不是分散的护理。
Many Veterans treated within the VA Healthcare System (VA) are also enrolled in fee-for-service (FFS) Medicare and receive treatment outside the VA. Prior research has not accounted for the multiple ways that Veterans receive services across healthcare systems.We aimed to establish a typology of VA and Medicare utilization among dually enrolled Veterans with type 2 diabetes.This was a retrospective cohort.316,775 community-dwelling Veterans age a parts per thousand yen 65 years with type 2 diabetes who were dually enrolled in the VA and FFS Medicare in 2008-2009.Using latent class analysis, we identified classes of Veterans based upon their probability of using VA and Medicare diabetes care services, including patient visits, laboratory tests, glucose test strips, and medications. We compared the amount of healthcare use between classes and identified factors associated with class membership using multinomial regression.We identified four distinct latent classes: class 1 (53.9 %) had high probabilities of VA use and low probabilities of Medicare use; classes 2 (17.2 %), 3 (21.8 %), and 4 (7.0 %) had high probabilities of VA and Medicare use, but differed in their Medicare services used. For example, Veterans in class 3 received test strips exclusively through Medicare, while Veterans in class 4 were reliant on Medicare for medications. Living a parts per thousand yen 40 miles from a VA predicted membership in classes 3 (OR 1.1, CI 1.06-1.15) and 4 (OR 1.11, CI 1.04-1.18), while Medicaid eligibility predicted membership in class 4 (OR 4.30, CI 4.10-4.51).Veterans with diabetes can be grouped into four distinct classes of dual health system use, representing a novel way to characterize how patients use multiple services across healthcare systems. This classification has applications for identifying patients facing differential risk from care fragmentation.