Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
J Gen Intern Med. 2011 Nov;26 Suppl 2(Suppl 2):669-75. doi: 10.1007/s11606-011-1788-4.
The objective of the study is to examine the association between ambulatory care sensitive hospitalizations (ACSH) and dual Medicare/Veteran Health Administration use.
A nationally representative sample of Medicare beneficiaries, who participated in the Medicare Current Beneficiary Survey (MCBS).
DESIGN/MEASUREMENTS: Cross-sectional analyses (N = 44,988) of linked fee-for-service Medicare claims and survey data from multiple years of the MCBS (2001-2005). Any ACSH and specific types of ACSH were measured using the list of prevention quality indicators developed by the Agency for Healthcare Research and Quality. Among veterans, dual Medicare/VHA use was defined as having inpatient or outpatient visits paid by VHA and consisted of three categories: 1) predominant-VHA use; 2) some VHA use and no VHA use. Unadjusted group differences in any ACSH were tested using chi-square tests. Logistic regressions were used to analyze the association between dual Medicare/VHA use and ACSH after controlling for demographic, socio-economic status, health status, functional status, smoking status and obesity. All analyses accounted for the complex design of the MCBS.
Among inpatient users, 10.1% had ACSH events for acute conditions and 15.8% for chronic conditions. Among all survey respondents, 5% had any ACSH event. Among predominant-VHA users the rate was 4.9% and among veterans with some VHA use it was 3.7%. In bivariate and multivariate analyses, dual Medicare/VHA use was not significantly associated with any ACSH.
In a representative sample of Medicare beneficiaries, despite low income and health status, veterans with dual Medicare/VHA use were as likely as veterans without dual use to have any ACSH, perhaps due to expanded healthcare access and emphasis on primary care in the VHA system.
本研究旨在探讨门诊医疗敏感住院（ACSH）与双重医疗保险/退伍军人健康管理局使用之间的关联。
参与医疗保险当前受益人大调查（MCBS）的医疗保险受益人的全国代表性样本。
设计/测量：使用医疗保健研究和质量局制定的预防质量指标清单，对来自 MCBS 多年（2001-2005 年）的链接费用服务医疗保险索赔和调查数据进行横截面分析（N=44988）。任何 ACSH 和特定类型的 ACSH 均通过该清单进行衡量。在退伍军人中，双重医疗保险/VHA 使用的定义是指由 VHA 支付的住院或门诊就诊，包括以下三个类别：1）主要 VHA 使用；2）一些 VHA 使用且无 VHA 使用。使用卡方检验测试未经调整的任何 ACSH 组间差异。使用逻辑回归分析在控制人口统计学，社会经济地位，健康状况，功能状态，吸烟状况和肥胖状况后，双重医疗保险/VHA 使用与 ACSH 之间的关联。所有分析均考虑了 MCBS 的复杂设计。
在住院患者中，10.1％的急性疾病和 15.8％的慢性疾病发生 ACSH 事件。在所有调查对象中，有 5％发生任何 ACSH 事件。在主要使用 VHA 的患者中，这一比例为 4.9％，在一些使用 VHA 的退伍军人中，这一比例为 3.7％。在单变量和多变量分析中，双重医疗保险/VHA 使用与任何 ACSH 均无显著关联。
在医疗保险受益人的代表性样本中，尽管收入和健康状况较低，但与没有双重使用的退伍军人相比，使用双重医疗保险/VHA 的退伍军人发生任何 ACSH 的可能性相同，这可能是由于 VHA 系统扩大了医疗保健机会并强调了初级保健。
