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

描述(由申请人提供)： 目的：本研究的目的是比较退伍军人管理局和联邦医疗保险在医疗保健服务的实践风格和成本方面的实践风格和机构间差异。具体目标是：AIM1：描述在退伍军人管理局接受治疗的符合联邦医疗保险资格的退伍军人和那些在按服务收费(FFS)医疗保险中接受护理的退伍军人之间的护理风格差异。目的：比较退伍军人管理局和整个医疗保险机构在实践风格上的机构间差异。研究计划：拟议的研究是一项队列分析，使用退伍军人管理局数据库中的回溯性患者数据、联邦医疗保险索赔以及对退伍军人和医疗保险参与者的现有调查(登记退伍军人的大型健康调查和患者的健康体验调查)。研究人群包括符合联邦医疗保险资格的患者，他们对目标1的登记退伍军人大型健康调查做出了回应，以及针对目标2的2009-11财年退伍军人健康体验调查(SHEP)的退伍军人受访者。方法：目标1是对符合联邦医疗保险资格的退伍军人队列的利用情况进行的纵向分析。我们使用因果统计模型来估计退伍军人与联邦医疗保险为这些退伍军人提供的护理风格的差异。目标2是一项横断面分析，使用回归分析来检验设施间VA费用差异与利用率之间的关系，控制患者的人口统计数据和共病情况。

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.