State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis

Authors

Drew A. Helmer, Veterans Affairs New Jersey Medical Center & Rutgers UniversityFollow
Mazhgan Rowneki, Veterns Affairs New Jersey Medical Center
Xue Feng, West Virginia University
Chin-lin Tseng, Veterans Affairs New Jersey Medical Center
Danielle Rose, Veteran Affairs Greater Los Angeles Healthcare System
Orysya Soroka, Veterans Affairs New Jersey Medical Center
Dennis Fried, Veterans Affairs New Jersey Medical Center
Nisha Jani, Veterans Affairs New Jersey Medical Center & Rutgers University
Leonard M. Pogach, Veterans Affairs New Jersey Medical Center
Usha Sambamoorthi, West Virginia University

Author ORCID Identifier

https://orcid.org/0000-0003-0385-432X

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https://orcid.org/0000-0003-3517-0758

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Document Type

Article

Publication Date

2018

College/Unit

School of Medicine

Department/Program/Center

Medicine

Abstract

Most Veterans who use the Veterans Health Administration (VHA) also utilize private-sector health care providers. To better inform local and regional health care planning, we assessed the association between reliance on VHA ambulatory care and total and system-specific preventable hospitalization rates (PHRs) at the state level. We conducted a retrospective dynamic cohort study using Veterans with diabetes mellitus, aged 66 years or older, and dually enrolled in VHA and Medicare parts A and B from 2004 to 2010. While controlling for median age and proportion of males, we measured the association between reliance on VHA ambulatory care and PHRs at the state level using multivariable ordinary least square regression, geographically weighted regression, and generalized additive models. We measured geospatial patterns in PHRs using global Moran’s I and univariate local indicator spatial analysis. Approximately 30% of hospitalized Veterans experienced a preventable hospitalization. Reliance on VHA ambulatory care at the state level ranged from 13.92% to 67.78% and was generally not associated with PHRs. Geospatial analysis consistently identified a cluster of western states with low PHRs from 2006 to 2010. Given the generally low reliance on VHA ambulatory care and lack of association between this reliance and PHRs, policy changes to improve Veterans’ health care outcomes should address private-sector care in addition to VHA care.

Digital Commons Citation

Helmer, Drew A.; Rowneki, Mazhgan; Feng, Xue; Tseng, Chin-lin; Rose, Danielle; Soroka, Orysya; Fried, Dennis; Jani, Nisha; Pogach, Leonard M.; and Sambamoorthi, Usha, "State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis" (2018). Faculty & Staff Scholarship. 1823.
https://researchrepository.wvu.edu/faculty_publications/1823

Source Citation

Helmer, D. A., Rowneki, M., Feng, X., Tseng, C., Rose, D., Soroka, O., Fried, D., Jani, N., Pogach, L. M., & Sambamoorthi, U. (2018). State-Level Variability in Veteran Reliance on Veterans Health Administration and Potentially Preventable Hospitalizations: A Geospatial Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 55, 4695801875621. https://doi.org/10.1177/0046958018756216

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