Rinne Seppo T, Elwy Anashua R, Bastian Lori A, Wong Edwin S, Wiener Renda S, Liu Chuan-Fen
*Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford †The Pulmonary Center, Boston University School of Medicine ‡Department of Veterans Affairs, VA Boston Healthcare System §Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA ∥Department of Veterans Affairs, Pain Research, Informatics, Multimorbidity and Education Center, VA Connecticut Healthcare System, West Haven ¶Department of Medicine, Yale University, New Haven, CT #Department of Veterans Affairs, Health Services Research and Development Center, VA Puget Sound Health Care System **Department of Health Services, University of Washington, Seattle, WA.
Med Care. 2017 Jul;55 Suppl 7 Suppl 1:S20-S25. doi: 10.1097/MLR.0000000000000708.
Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown.
To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD.
This is a retrospective cohort study using VA administrative data and Medicare claims.
In total, 20,472 Medicare-eligible veterans who were admitted to VA hospitals for COPD during October 1, 2008 and September 30, 2011.
We identified the source of outpatient care during the year before the index hospitalization as VA-only, dual-care (VA and Medicare), and Medicare-only. Outcomes of interest included any-cause 30-day readmission, COPD-specific 30-day readmission and follow-up visit within 30 days of discharge. We used mixed-effects logistic regression, controlling for baseline severity of illness, to examine the association between non-VA care and postdischarge outcomes.
There was no association between non-VA care and any-cause readmission. We did identify an increased COPD-specific readmission risk with both dual-care [odds ratio (OR)=1.20; 95% confidence interval (CI), 1.02-1.40] and Medicare-only (OR=1.41; 95% CI, 1.15-1.75). Medicare-only outpatient care was also associated with significantly lower rates of follow-up (OR=0.81; 95% CI, 0.72-0.91).
Differences in disease-specific readmission risk may reflect differences in disease management between VA and non-VA providers. Further research is needed to understand how multisystem care affects coordination and other measures of quality for veterans with COPD.
慢性阻塞性肺疾病（COPD）是退伍军人事务部（VA）医院再次入院的最常见原因之一。先前的研究表明，患有多系统医疗保健问题的退伍军人预后较差，不过非VA医疗对COPD再次入院的影响尚不清楚。
探讨在VA医院因COPD入院的退伍军人中，使用非VA门诊医疗与30天再入院率及30天随访之间的关联。
这是一项使用VA行政数据和医疗保险索赔数据的回顾性队列研究。
2008年10月1日至2011年9月30日期间在VA医院因COPD入院的20472名符合医疗保险资格的退伍军人。
我们将索引住院前一年的门诊医疗来源确定为仅VA医疗、双重医疗（VA和医疗保险）以及仅医疗保险。感兴趣的结果包括任何原因的30天再入院、COPD特定的30天再入院以及出院后30天内的随访就诊。我们使用混合效应逻辑回归，控制疾病的基线严重程度，以研究非VA医疗与出院后结果之间的关联。
非VA医疗与任何原因的再入院之间没有关联。我们确实发现，双重医疗[比值比（OR）=1.20；95%置信区间（CI），1.02 - 1.40]和仅医疗保险（OR = 1.41；95% CI，1.15 - 1.75）的COPD特定再入院风险均增加。仅医疗保险的门诊医疗也与显著较低的随访率相关（OR = 0.81；95% CI，0.72 - 0.91）。
疾病特定再入院风险的差异可能反映了VA和非VA医疗服务提供者在疾病管理方面的差异。需要进一步研究以了解多系统医疗如何影响COPD退伍军人的协调及其他质量指标。
