Differences in use of Veterans Health Administration and non-Veterans Health Administration hospitals by rural and urban Veterans after access expansions.

Autor: Dizon MP; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.; Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA., Kizer KW; Stanford University School of Medicine, Stanford, California, USA., Ong MK; Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; David Geffen School of Medicine and Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California, USA., Phibbs CS; Department of Health Policy, Stanford University School of Medicine, Stanford, California, USA.; Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA., Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.; Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Wong EP; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA., Zhang Y; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.; Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA., Yoon J; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA.; Department of General Internal Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA.
Jazyk: angličtina
Zdroj: The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2024 Jun; Vol. 40 (3), pp. 446-456. Date of Electronic Publication: 2023 Nov 30.
DOI: 10.1111/jrh.12812
Abstrakt: Purpose: To examine changes in rural and urban Veterans' utilization of acute inpatient care in Veterans Health Administration (VHA) and non-VHA hospitals following access expansion from the Veterans Choice Act, which expanded eligibility for VHA-paid community hospitalization.
Methods: Using repeated cross-sectional data of VHA enrollees' hospitalizations in 9 states (AZ, CA, CT, FL, LA, MA, NY, PA, and SC) between 2012 and 2017, we compared rural and urban Veterans' probability of admission in VHA and non-VHA hospitals by payer over time for elective and nonelective hospitalizations using multinomial logistic regression to adjust for patient-level sociodemographic features. We also used generalized linear models to compare rural and urban Veterans' travel distances to hospitals.
Findings: Over time, the probability of VHA-paid community hospitalization increased more for rural Veterans than urban Veterans. For elective inpatient care, rural Veterans' probability of VHA-paid admission increased from 2.9% (95% CI 2.6%-3.2%) in 2012 to 6.5% (95% CI 5.8%-7.1%) in 2017. These changes were associated with a temporal trend that preceded and continued after the implementation of the Veterans Choice Act. Overall travel distances to hospitalizations were similar over time; however, the mean distance traveled decreased from 39.2 miles (95% CI 35.1-43.3) in 2012 to 32.3 miles (95% CI 30.2-34.4) in 2017 for rural Veterans receiving elective inpatient care in VHA-paid hospitals.
Conclusions: Despite limited access to rural hospitals, these data demonstrate an increase in rural Veterans' use of non-VHA hospitals for acute inpatient care and a small reduction in distance traveled to elective inpatient services.
(Published 2023. This article is a U.S. Government work and is in the public domain in the USA.)
Databáze: MEDLINE
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