Differences in Practice Styles in VA and Medicare: Causes and Implications

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DESCRIPTION (provided by applicant): Objectives: The objective of this study is to compare practice styles, and inter-facility variationin practice styles and costs of health care services, in VA and Medicare. Specific aims are: Aim1: To characterize differences in the style of care between Medicare-eligible Veterans treated at the VA and those receiving care in Fee-for-Service (FFS) Medicare. Aim2: To compare inter-facility variation in practice style in the VA to that observed for Medicare as a whole. Research Plan: The proposed study is a cohort analysis using retrospective patient data from VA administrative databases, Medicare claims, and existing surveys of VA and Medicare enrollees (Large Health Survey of Enrolled Veterans, and the VA Survey of Health Experiences of Patients). The study population consists of Medicare-eligible patients who responded to the Large Health Survey of Enrolled Veterans for Aim 1, and veteran respondents to the FY2009-11 VA Survey of Health Experiences of Patients (SHEP) for Aim 2. Methodology: Aim 1 is a longitudinal analysis of utilization within the VA and in Medicare for a cohort of Medicare eligibl Veterans. We use causal statistical models to estimate differences in the style of care provided by VA versus Medicare for these Veterans. Aim 2 is a cross sectional analysis using regression analysis to test the relationship between inter-facility variation in VA costs and utilization, controlling for patient demographics and comorbid conditions.