Wolinsky Fredric D, Miller Thomas R, An Hyonggin, Brezinski Paul R, Vaughn Thomas E, Rosenthal Gary E
Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Health Care System, 601 Highway 6 West, Iowa City, IA52246, USA.
BMC Health Serv Res. 2006 Oct 9;6:131. doi: 10.1186/1472-6963-6-131.
Millions of veterans are eligible to use the Veterans Health Administration (VHA) and Medicare because of their military service and age. This article examines whether an indirect measure of dual use based on inpatient services is associated with increased mortality risk.
Data on 1,566 self-responding men (weighted N = 1,522) from the Survey of Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to Medicare claims and the National Death Index. Dual use was indirectly indicated when the self-reported number of hospital episodes in the 12 months prior to baseline was greater than that observed in the Medicare claims. The independent association of dual use with mortality was estimated using proportional hazards regression.
96 (11%) of the veterans were classified as dual users. 766 men (50.3%) had died by December 31, 2002, including 64.9% of the dual users and 49.3% of all others, for an attributable mortality risk of 15.6% (p < .003). Adjusting for demographics, socioeconomics, comorbidity, hospitalization status, and selection bias at baseline, as well as subsequent hospitalization for ambulatory care sensitive conditions, the independent effect of dual use was a 56.1% increased relative risk of mortality (AHR = 1.561; p = .009).
An indirect measure of veterans' dual use of the VHA and Medicare systems, based on inpatient services, was associated with an increased risk of death. Further examination of dual use, especially in the outpatient setting, is needed, because dual inpatient and dual outpatient use may be different phenomena.
数百万退伍军人因其服役经历和年龄而有资格使用退伍军人健康管理局（VHA）和医疗保险。本文探讨基于住院服务的双重使用间接指标是否与死亡风险增加相关。
来自“最年长者资产与健康动态调查”（AHEAD）的1566名自填问卷男性（加权N = 1522）的数据与医疗保险理赔记录和国家死亡指数相链接。当基线前12个月自我报告的住院次数大于医疗保险理赔记录中观察到的次数时，间接表明存在双重使用情况。使用比例风险回归估计双重使用与死亡率的独立关联。
96名（11%）退伍军人被归类为双重使用者。到2002年12月31日，766名男性（50.3%）已经死亡，其中包括64.9%的双重使用者和49.3%的其他所有人，归因死亡风险为15.6%（p <.003）。在调整了人口统计学、社会经济学、合并症、住院状态、基线时的选择偏倚以及随后因门诊护理敏感疾病而住院的情况后，双重使用的独立影响是死亡相对风险增加56.1%（风险比 = 1.561；p =.009）。
基于住院服务的退伍军人双重使用VHA和医疗保险系统的间接指标与死亡风险增加相关。需要进一步研究双重使用情况，尤其是在门诊环境中，因为住院双重使用和门诊双重使用可能是不同的现象。
