Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis
Corresponding Author
Virginia Wang Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
Address correspondence to Virginia Wang, Ph.D., Center for Health Services Research in Primary Care, Durham VA Health Care System and Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 508 Fulton St., Durham, NC 27705; e-mail: [email protected].Search for more papers by this authorCynthia J. Coffman Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
Search for more papers by this authorKaren M. Stechuchak M.S.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorTheodore S.Z. Berkowitz M.S.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorPaul L. Hebert Ph.D.
Center for Health Services Research in Older Adults, Puget Sound Health Care System, Seattle, WA
Department of Health Services, School of Public Health, University of Washington, Seattle, WA
Search for more papers by this authorDavid Edelman M.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
Search for more papers by this authorAnn M. O'Hare M.D.
Center for Health Services Research in Older Adults, Puget Sound Health Care System, Seattle, WA
Department of Medicine, University of Washington, Seattle, WA
Search for more papers by this authorHollis J. Weidenbacher Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorMatthew L. Maciejewski Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Population Health Sciences, Duke University, Durham, NC
Search for more papers by this authorCorresponding Author
Virginia Wang Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
Address correspondence to Virginia Wang, Ph.D., Center for Health Services Research in Primary Care, Durham VA Health Care System and Department of Population Health Sciences and Division of General Internal Medicine, Duke University School of Medicine, 508 Fulton St., Durham, NC 27705; e-mail: [email protected].Search for more papers by this authorCynthia J. Coffman Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
Search for more papers by this authorKaren M. Stechuchak M.S.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorTheodore S.Z. Berkowitz M.S.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorPaul L. Hebert Ph.D.
Center for Health Services Research in Older Adults, Puget Sound Health Care System, Seattle, WA
Department of Health Services, School of Public Health, University of Washington, Seattle, WA
Search for more papers by this authorDavid Edelman M.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC
Search for more papers by this authorAnn M. O'Hare M.D.
Center for Health Services Research in Older Adults, Puget Sound Health Care System, Seattle, WA
Department of Medicine, University of Washington, Seattle, WA
Search for more papers by this authorHollis J. Weidenbacher Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Search for more papers by this authorMatthew L. Maciejewski Ph.D.
Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care System, Durham, NC
Department of Population Health Sciences, Duke University, Durham, NC
Search for more papers by this authorAbstract
Objective
Growing demand for VA dialysis exceeds its supply and travel distances prohibit many Veterans from receiving dialysis in a VA facility, leading to increased use of dialysis from non-VA providers. This study compared utilization and hospitalization outcomes among Veterans receiving chronic dialysis in VA and non-VA settings in 2008–2013.
Data Sources
VA, Medicare, and national disease registry data.
Study Design
National cohort of 27,301 Veterans initiating dialysis, observed for a period of 2 years after treatment initiation. We used multinomial logistic regression to examine associations between patient characteristics and dialysis use in VA, non-VA community settings via VA Purchased Care (VA-PC), community settings via Medicare, or Dual settings. Zero-inflated negative binomial regression was used to compare risk of hospitalization and days spent in the hospital across dialysis settings.
Principal Findings
Sixty-seven percent of Veterans obtained community-based dialysis exclusively via Medicare, 11 percent in the community via VA-PC, 4 percent in VA, and 18 percent in Dual settings. Financial and geographic access factors were important predictors of dialysis setting, but days spent in the hospital and risk of hospitalization did not differ meaningfully across settings.
Conclusions
Most Veterans obtained dialysis in the community. Dialysis setting appeared to have little impact on risk of hospitalization among Veterans.
Supporting Information
| Filename | Description |
|---|---|
| hesr13022-sup-0001-AuthorMatrix.pdfPDF document, 1.2 MB | Appendix SA1: Author Matrix. |
| hesr13022-sup-0002-AppendixSA2-SA7.docxWord document, 295.4 KB |
Appendix SA2: Sampling Frame. Appendix SA3. Visualization of Veteran Dialysis Settings, by Quarter. Appendix SA4. All Veteran Patient Characteristics at Dialysis Initiation, Overall and by Veterans’ Dialysis Setting. Appendix SA5. Regional Variation in Cross-Sectional (Overall) Dialysis Setting, by Veterans. Integrated Service Network (VISN). Appendix SA6. Multinomial Regression Model Output for Dialysis Setting Utilization. Appendix SA7. Technical Description and Full Set of Regression Results: Zero-Inflated Negative Binomial Regression Model Examining Number of Hospital Days over 2 Years Follow-Up Period from Chronic Dialysis Initiation. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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