Dual Use of VA and Non-VA Healthcare Services Among Veterans Younger than 65

65 岁以下退伍军人双重使用 VA 和非 VA 医疗服务

• 批准号: 8696874
• 负责人: MARY E. CHARLTON
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-11-01 至 2015-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8696874
• 关键词: Address; Admission activity; Age; Amputation; Area; Caring; Categories; Characteristics; Code; Conflict (Psychology); Data; Data Element; Data Set; Data Sources; Databases; Diagnosis; Diagnostic; Diagnostic Procedure; Disabled Persons; Elderly; Enrollment; Family; Gender; Health; Health Care Reform; Health Insurance; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home environment; Hospitalization; Image; Imaging Techniques; Improve Access; Information Systems; Inpatients; Insurance; Iowa; Knowledge; Life; Logistic Regressions; Maine; Medical; Medicare; Mental Health Services; Methods; New Hampshire; Occupations; Outcome; Outpatients; Patients; Pattern; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacy facility; Policies; Population; Post-Traumatic Stress Disorders; Private Sector; Procedures; Process; Provider; Quality of Care; Records; Research Personnel; Resource Allocation; Resources; Risk; Rural; Services; Source; South Dakota; Strategic Planning; System; Therapeutic; Time; Traumatic Brain Injury; Veterans; Woman; Work; adverse outcome; care systems; cost; demographics; design; evidence base; human old age (65+); improved; meetings; men; programs; residence; wasting

DESCRIPTION (provided by applicant): Background: VA enrollment has been extended to OEF/OIF/OND Veterans for a minimum of five years, and as a result, enrollment has grown sharply. Unprecedented proportions of these newer enrollees are Reservists or National Guardsmen returning to or finding jobs with private health insurance. Their capacity to use both VA and private sector care is unparalleled among Veterans under 65, and studies suggest that roughly half may be "dual users." Dual use of health care systems raises several concerns, including discontinuity in care, duplicative treatments, and increased costs, but few studies have examined potential adverse outcomes of dual use. Because obtaining private insurance claims information is difficult, no studies have comprehensively examined dual use and associated outcomes among VA enrollees younger than 65 who have private insurance. Knowledge of dual use patterns could substantially enhance efforts to achieve three of Secretary Shinseki's top priorities: 1) strengthening access for rural Veterans, 2) expanding health programs for women Veterans, and 3) improving the quality, access, and value of mental health services. The proposed study will advance our understanding of how younger Veterans in rural states use VA, the private sector, or both systems for particular services and needs, and whether dual use is associated with benefits or risks. Objectives: Quantify the extent of VA, private sector and dual health care use among VA enrollees with private insurance, determine associations between dual use and demographics such as gender, urban-rural residence, distance to care, illnesses and health system factors, and evaluate differences in quality of care received by dual users compared to single system users, such as receipt of recommended treatments for post traumatic stress disorder and occurrences of therapeutic duplication or redundant procedures (e.g. high-cost imaging). Methods: We will assess comprehensive utilization patterns of VA enrollees with private health insurance who are younger than 65 and living in four states from 2001 through 2010 (available years vary by data source). We will obtain non-VA claims data from Wellmark BCBS of Iowa and South Dakota, and from the New Hampshire and Maine All Payer Claims Databases. Under a method we have applied previously, VA's National Data Systems (NDS) will provide each of the non-VA data sources with identifiers for all enrollees living in the state at any time during relevant years; the sources will use the identifiers to search for matching records, along with a non-reversible unique ID (UID). Matching records will be sent to NDS with the UID for each patient, but without SSNs or birthdates. The UID will be the only identifier the investigators will receive, but it will enable them to detect dual users without compromising sensitive patient information. Data elements will include demographics, inpatient and outpatient claims (including diagnosis and procedure codes) and pharmacy data; Poisson and logistic regressions will be used to compare VA-only, private sector-only, and dual users on utilization rates, receipt of recommended, quality care, occurrences of avoidable admissions and readmissions, and duplicative care related to medications and imaging, controlling for urban-rural residence, distance to care, gender, VA priority status, diagnostic categories, and types of medical services.

描述(由申请人提供)： 背景：退伍军人管理局的注册已扩大到OEF/OIF/OND退伍军人至少五年，因此，注册人数急剧增长。这些新登记的人中，史无前例的是预备役军人或国民警卫队人员，他们回到私人医疗保险公司或通过私人医疗保险找到工作。在65岁以下的退伍军人中，他们同时使用退伍军人管理局和私营部门护理的能力是无与伦比的，研究表明，大约一半的退伍军人可能是“双重使用者”。卫生保健系统的双重使用引起了几个问题，包括护理中断、重复治疗和成本增加，但很少有研究检查双重使用的潜在不良后果。由于很难获得私人保险索赔信息，因此还没有研究全面检查65岁以下拥有私人保险的退伍军人管理局登记人的双重用途和相关结果。对两用模式的了解可以大大加强努力，以实现新关部长的三个首要任务：1)加强农村退伍军人的机会，2)扩大女性退伍军人的健康计划，3)提高精神卫生服务的质量、机会和价值。拟议的研究将促进我们了解农村州的年轻退伍军人如何使用退伍军人管理局、私营部门或这两个系统来满足特定的服务和需求，以及双重使用是否与好处或风险相关。目的：量化退伍军人管理局、私营部门和拥有私人保险的退伍军人管理局登记人员中双重保健服务的使用程度，确定双重用途与人口统计学因素之间的关系，如性别、城乡居住地、护理距离、疾病和卫生系统因素，并评估双重使用者与单一系统使用者接受的护理质量的差异，例如接受创伤后应激障碍的推荐治疗以及治疗重复或重复程序的发生(例如，高成本成像)。方法：我们将评估2001年至2010年在四个州居住的65岁以下的退伍军人管理局登记人员的综合利用模式(可用年限因数据来源而异)。我们将从爱荷华州和南达科他州的Wellmark BCBS以及新汉普郡和缅因州的All Payer索赔数据库获得非退伍军人索赔数据。根据我们以前应用的一种方法，退伍军人事务部的国家数据系统(NDS)将在相关年份的任何时间向每个非退伍军人数据来源提供居住在该州的所有参与者的标识；这些来源将使用这些标识符来搜索匹配的记录，以及不可逆的唯一ID(UID)。匹配的记录将被发送到NDS，其中包含每个患者的UID，但没有SSN或出生日期。UID将是调查人员将使用的唯一标识 接收，但这将使他们能够检测双重用户，而不会损害敏感的患者信息。数据元素将包括人口统计学、住院和门诊索赔(包括诊断和程序代码)和药房数据；泊松和Logistic回归将用于比较仅限退伍军人管理局、仅限私营部门和双重用户的使用率、建议的收治、质量护理、可避免的入院和再入院的发生情况，以及与药物和成像有关的重复护理、城乡居住控制、护理距离、性别、退伍军人管理局优先地位、诊断类别和医疗服务类型。