Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare?
- 1 February 1997
- journal article
- Vol. 31 (6), 739-54
Abstract
To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use of cardiac procedures in both systems, and patient mortality. Merging of inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) and Medicare MedPAR Part A files. A retrospective cohort study of male veterans 65 years or older who were prior users of the VA medical system (veteran-users) and who were initially admitted to a VA or Medicare hospital with a primary diagnosis of AMI at some time from January 1, 1988 through December 31, 1990 (N = 25,312). We examined the use of cardiac catheterization, coronary bypass surgery, and percutaneous transluminal coronary angioplasty in the 90 days after initial admission for AMI in both VA and Medicare systems, and survival at 30 days, 90 days, and one year. Other key measures included patient age, race, marital status, comorbidities, cardiac complications, prior utilization, and the availability of cardiac technology at the admitting hospital. More than half of veteran-users (54 percent) were initially hospitalized in a Medicare hospital when they suffered an AMI. These Medicare index patients were more likely to receive cardiac catheterization (OR 1.24, 95% C.I. 1.17-1.32), coronary bypass surgery (OR 2.01, 95% C.I. 1.83-2.20), and percutaneous transluminal coronary angioplasty (OR 2.56, 95% C.I. 2.30-2.85) than VA index patients. Small proportions of patients crossed over between systems of care for catheterization procedures (VA to Medicare = 3.3%, and Medicare to VA = 5.1%). Many VA index patients crossed over to Medicare hospitals to obtain bypass surgery (27.6 percent) or coronary angioplasty (12.1 percent). Mortality was not significantly different between veteran-users who were initially admitted to VA versus Medicare hospitals. Dual-system utilization highlights the need to look at both systems of care when evaluating access, costs, and quality either in VA or in Medicare systems. Policy changes that affect access to and utilization of one system may lead to unpredictable results in the other.This publication has 17 references indexed in Scilit:
- Development and validation of a claims based index for adjusting for risk of mortality: The case of acute myocardial infarctionJournal of Clinical Epidemiology, 1995
- The Future of the Department of Veterans Affairs Health Care SystemJama-Journal Of The American Medical Association, 1995
- Discordance of Databases Designed for Claims Payment versus Clinical Information Systems: Implications for Outcomes ResearchAnnals of Internal Medicine, 1993
- High-technology cardiac procedures. The impact of service availability on service use in New York StateJAMA, 1993
- Comparison of Postoperative Mortality in VA and Private HospitalsAnnals of Surgery, 1993
- Studying Outcomes and Hospital Utilization in the ElderlyMedical Care, 1992
- Differences in the Use of Procedures between Women and Men Hospitalized for Coronary Heart DiseaseThe New England Journal of Medicine, 1991
- Older Veterans?? Future Use of VA Health Care ServicesMedical Care, 1988
- Cost-effectiveness analysis of patient management alternatives after uncomplicated myocardial infarction: A modelJournal of the American College of Cardiology, 1987
- Determinants of VA utilization. The 1983 survey of aging veterans.1987