Exploring the Link between Ambulatory Care and Avoidable Hospitalizations at the Veteran Health Administration

Abstract

This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

The VA Medical Foster Home Program, Ambulatory Care Sensitive Conditions, and Avoidable Hospitalizations

“…These findings may be used to influence enrollment in MFH programs. Although reductions in avoidable hospitalizations through enhanced access to primary care have been demonstrated previously, 2,4,8,13 the present results are particularly noteworthy because the MFH population is considered "more medically complex and disabled." Furthermore, a companion study focusing primarily on hospitalization but also the comparative effectiveness of the MFH program found that "incidents of adverse medical care resulting in hospitalization were less prevalent among MFH than CLC residents," whereas "no differences between the groups were observed for adverse drug events, falls or other injuries.…”

“…This variable tends to be uncorrelated with the health outcome in question but significantly affects the frequency at which care is sought. 4 However, in the present analysis, concerns related to this potential bias are alleviated somewhat by the intertemporal differences across the ACSCs. In particular, the most significant (both statistically and practically) differences were recorded for CHF (57%) and COPD (54%).…”

“…1,2 Therefore, the rate of avoidable hospitalizations in a defined population represents a convenient way to assess the effectiveness of interventions aimed at improving access to and quality of ambulatory care. [2][3][4] The objective of this study is to evaluate the Veterans Administration (VA) Medical Foster Home (MFH) program, which was designed as an alternative to traditional nursing home care. The hypothesis tested here is that the comparative effectiveness of the VA MFH program will manifest itself as a reduction in the rate of avoidable hospitalizations for participants following enrollment.…”

“…Pracht and Bass used an instrumental variables model to examine the substitutability of ambulatory care for inpatient care within the VA system, focusing on patients with ACSCs; their results documented the potential for significant reductions in avoidable hospitalizations by emphasizing ambulatory care. 4 More recently, Edwards et al 10 examined the probability of hospitalization among older veterans with diabetes mellitus, one of the ACSCs studied here, following enrollment in HBPC. Using a similar instrumental variables approach to control for selection biases, they found that patients in HBPC were significantly less likely to be hospitalized for an ACSC.…”