Lower comorbidity scores and severity levels in Veterans Health Administration hospitals: a cross-sectional study.

Autor: Dizon MP; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, USA. Matthew.Dizon@va.gov.; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA. Matthew.Dizon@va.gov., Chow A; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA., Ong MK; Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.; David Geffen School of Medicine and Fielding School of Public Health, UCLA, Los Angeles, CA, USA., Phibbs CS; Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA.; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA., Vanneman ME; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.; Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA., Zhang Y; Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.; Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA., Yoon J; Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.; Department of General Internal Medicine, School of Medicine, University of California at San Francisco, San Francisco, CA, USA.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 May 08; Vol. 24 (1), pp. 601. Date of Electronic Publication: 2024 May 08.
DOI: 10.1186/s12913-024-11063-3
Abstrakt: Background: Previous studies found that documentation of comorbidities differed when Veterans received care within versus outside Veterans Health Administration (VHA). Changes to medical center funding, increased attention to performance reporting, and expansion of Clinical Documentation Improvement programs, however, may have caused coding in VHA to change.
Methods: Using repeated cross-sectional data, we compared Elixhauser-van Walraven scores and Medicare Severity Diagnosis Related Group (DRG) severity levels for Veterans' admissions across settings and payers over time, utilizing a linkage of VHA and all-payer discharge data for 2012-2017 in seven US states. To minimize selection bias, we analyzed records for Veterans admitted to both VHA and non-VHA hospitals in the same year. Using generalized linear models, we adjusted for patient and hospital characteristics.
Results: Following adjustment, VHA admissions consistently had the lowest predicted mean comorbidity scores (4.44 (95% CI 4.34-4.55)) and lowest probability of using the most severe DRG (22.1% (95% CI 21.4%-22.8%)). In contrast, Medicare-covered admissions had the highest predicted mean comorbidity score (5.71 (95% CI 5.56-5.85)) and highest probability of using the top DRG (35.3% (95% CI 34.2%-36.4%)).
Conclusions: More effective strategies may be needed to improve VHA documentation, and current risk-adjusted comparisons should account for differences in coding intensity.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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