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：VA 招生范围已扩大到 OEF/OIF/OND 退伍军人至少五年，因此招生人数急剧增加。这些新参保者中预备役军人或国民警卫队人员返回私人医疗保险或寻找工作的比例是前所未有的。在 65 岁以下的退伍军人中，他们同时使用 VA 和私营部门护理的能力是无与伦比的，研究表明，大约一半的人可能是“双重用户”。医疗保健系统的双重使用引起了一些担忧，包括护理的不连续性、重复治疗和成本增加，但很少有研究探讨双重使用的潜在不良后果。由于获取私人保险索赔信息很困难，因此尚无研究全面调查 65 岁以下拥有私人保险的 VA 参保者的双重用途和相关结果。了解双重用途模式可以大大加强努力，以实现新关部长的三个首要优先事项：1) 加强农村退伍军人的获得机会，2) 扩大女性退伍军人的健康计划，以及 3) 提高精神卫生服务的质量、可及性和价值。拟议的研究将加深我们对农村州的年轻退伍军人如何使用退伍军人事务部、私营部门或这两个系统来满足特定服务和需求，以及双重使用是否与利益或风险相关的理解。目标：量化拥有私人保险的 VA 参保者对 VA、私营部门和双重医疗保健的使用程度，确定双重医疗保健与人口统计数据（如性别、城乡居住、就医距离、疾病和卫生系统因素）之间的关联，并评估双重使用者与单一系统使用者相比所接受的护理质量差异，例如接受针对创伤后应激障碍的推荐治疗以及治疗重复或冗余的发生情况 程序（例如高成本成像）。方法：我们将评估 2001 年至 2010 年间居住在四个州的 65 岁以下、拥有私人健康保险的 VA 参保者的综合利用模式（可用年份因数据源而异）。我们将从爱荷华州和南达科他州的 Wellmark BCBS 以及新罕布什尔州和缅因州所有付款人索赔数据库获取非 VA 索赔数据。根据我们之前采用的方法，VA 的国家数据系统 (NDS) 将为每个非 VA 数据源提供相关年份中任何时间居住在该州的所有参保者的标识符；源将使用标识符以及不可逆的唯一 ID (UID) 来搜索匹配的记录。匹配记录将发送至 NDS，其中包含每位患者的 UID，但不包含 SSN 或出生日期。 UID 将是调查人员唯一的标识符 接收，但这将使他们能够检测双重用户，而不会泄露敏感的患者信息。数据元素将包括人口统计、住院和门诊索赔（包括诊断和程序代码）以及药房数据；泊松和逻辑回归将用于比较纯 VA、纯私营部门和双重用户的利用率、接受推荐的优质护理、可避免的入院和再入院的发生率以及与药物和影像相关的重复护理，并控制城乡居住、到护理的距离、性别、VA 优先状态、诊断类别和医疗服务类型。