Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals.

Autor:	Yoon J; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.; Department of General Internal Medicine, University of California San Francisco School of Medicine, San Francisco., Phibbs CS; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.; Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Stanford, California., Ong MK; Veterans Affairs Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California.; Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles.; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles., Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.; Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City., Chow A; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California., Redd A; Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah., Kizer KW; Stanford University School of Medicine, Stanford, California., Dizon MP; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California., Wong E; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California., Zhang Y; Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.; Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2023 Dec 01; Vol. 6 (12), pp. e2345898. Date of Electronic Publication: 2023 Dec 01.
DOI:	10.1001/jamanetworkopen.2023.45898
Abstrakt:	Importance: Many veterans enrolled in the Veterans Affairs (VA) health care system have access to non-VA care through insurance and VA-purchased community care. Prior comparisons of VA and non-VA hospital outcomes have been limited to subpopulations. Objective: To compare outcomes for 6 acute conditions in VA and non-VA hospitals for younger and older veterans using VA and all-payer discharge data. Design, Setting, and Participants: This cohort study used a repeated cross-sectional analysis of hospitalization records for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), gastrointestinal (GI) hemorrhage, heart failure (HF), pneumonia, and stroke. Participants included VA enrollees from 11 states at VA and non-VA hospitals from 2012 to 2017. Analysis was conducted from July 1, 2022, to October 18, 2023. Exposures: Treatment in VA or non-VA hospital. Main Outcome and Measures: Thirty-day mortality, 30-day readmission, length of stay (LOS), and costs. Average treatment outcomes of VA hospitals were estimated using inverse probability weighted regression adjustment to account for selection into hospitals. Models were stratified by veterans' age (aged less than 65 years and aged 65 years and older). Results: There was a total of 593 578 hospitalizations and 414 861 patients with mean (SD) age 75 (12) years, 405 602 males (98%), 442 297 hospitalizations of non-Hispanic White individuals (75%) and 73 155 hospitalizations of non-Hispanic Black individuals (12%) overall. VA hospitalizations had a lower probability of 30-day mortality for HF (age ≥65 years, -0.02 [95% CI, -0.03 to -0.01]) and stroke (age <65 years, -0.03 [95% CI, -0.05 to -0.02]; age ≥65 years, -0.05 [95% CI, -0.07 to -0.03]). VA hospitalizations had a lower probability of 30-day readmission for CABG (age <65 years, -0.04 [95% CI, -0.06 to -0.01]; age ≥65 years, -0.05 [95% CI, -0.07 to -0.02]), GI hemorrhage (age <65 years, -0.04 [95% CI, -0.06 to -0.03]), HF (age <65 years, -0.05 [95% CI, -0.07 to -0.03]), pneumonia (age <65 years, -0.04 [95% CI, -0.06 to -0.03]; age ≥65 years, -0.03 [95% CI, -0.04 to -0.02]), and stroke (age <65 years, -0.11 [95% CI, -0.13 to -0.09]; age ≥65 years, -0.13 [95% CI, -0.16 to -0.10]) but higher probability of readmission for AMI (age <65 years, 0.04 [95% CI, 0.01 to 0.06]). VA hospitalizations had a longer mean LOS and higher costs for all conditions, except AMI and stroke in younger patients. Conclusions and Relevance: In this cohort study of veterans, VA hospitalizations had lower mortality for HF and stroke and lower readmissions, longer LOS, and higher costs for most conditions compared with non-VA hospitalizations with differences by condition and age group. There were tradeoffs between better outcomes and higher resource use in VA hospitals for some conditions.
Databáze:	MEDLINE
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