Improving Prediction of Long-Term Care Utilization Through Patient-Reported Measures: Cross-Sectional Analysis of High-Need U.S. Veterans Affairs Patients

Jacobs, Josephine; Maciejeweski, Matthew L.; Houtven, Courtney Harold Van; Lo, Jeanie; Greene, Liberty; Zulman, Donna M.

doi:10.1177/10775587211062403

Cited by 5 publications

(2 citation statements)

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“…To understand the prevalence of social risks and which risks might be predictive of outcomes in VA patients at high risk for hospitalization or death, the US Veterans Affairs (VA)'s Office of Primary Care conducted a mail survey in 2018 that included a comprehensive set of social, behavioral, and health measures. Prior analyses found that certain social risks predicted VA hospitalization, 6 ED use, 17 and long‐term care use, 18 but few studies have examined the association between social risks and health expenditures. In the current study, we examined the association between patient‐reported social and behavioral risks and VA expenditures across a broad range of Veteran‐reported social risks in a nationally representative sample of high‐risk Veterans who obtain VA healthcare.…”

Section: Introductionmentioning

confidence: 99%

Association between patient‐reported social and behavioral risks and health care costs in high‐risk Veterans health administration patients

Maciejewski,

Greene,

Grubber

et al. 2023

Health Services Research

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ObjectiveSocial risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient‐reported social risk, behavioral, and health factors associated with health expenditures in Veterans Affairs (VA) patients at high risk for hospitalization or death.Data Sources, Study Setting, and Study DesignProspective cohort study among high‐risk Veterans obtaining VA care. Patient‐reported social risk, function, and other measures derived from a 2018 survey sent to 10,000 VA patients were linked to clinical and demographic characteristics extracted from VA data. Response‐weighted generalized linear and marginalized two‐part models were used to examine VA expenditures (total, outpatient, medication, inpatient) 1 year after survey completion in adjusted models.Principal FindingsAmong 4680 survey respondents, the average age was 70.9 years, 6.3% were female, 16.7% were African American, 20% had body mass index ≥35, 42.4% had difficulty with two or more basic or instrumental activities of daily living, 19.3% reported transportation barriers, 12.5% reported medication insecurity and 21.8% reported food insecurity. Medication insecurity was associated with lower outpatient expenditures (−$1859.51 per patient per year, 95% confidence interval [CI]: −3200.77 to −518.25) and lower total expenditures (−$4304.99 per patient per year, 95% CI: −7564.87 to −1045.10). Transportation barriers were negatively associated with medication expenditures (−$558.42, 95% CI: −1087.93 to −31.91). Patients with one functional impairment had higher outpatient expenditures ($2997.59 per patient year, 95% CI: 1185.81–4809.36) than patients without functional impairments. No social risks were associated with inpatient expenditures.ConclusionsIn this study of VA patients at high risk for hospitalization and mortality, few social and functional measures were independently associated with the costs of VA care. Individuals with functional limitations and those with barriers to accessing medications and transportation may benefit from targeted interventions to ensure that they are receiving the services that they need.

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Section: Introductionmentioning

confidence: 99%

Association between patient‐reported social and behavioral risks and health care costs in high‐risk Veterans health administration patients

Maciejewski,

Greene,

Grubber

et al. 2023

Health Services Research

Self Cite

View full text Add to dashboard Cite

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“…To our knowledge, there has been no direct test of whether a 6‐month versus 12‐month look‐back period affects the prevalence of reported social risks. Furthermore, there is limited data on the prevalence of particular social risks among Veterans and their association with health 10–12 . The aims of this article are to compare the effects of 6‐ and 12‐month look‐back periods on the prevalence of reported social risks and to identify social risks that are correlated with overall health and mental health ratings among Veterans.…”

Section: Introductionmentioning

confidence: 99%

Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients

Hausmann,

Cohen,

Eliacin

et al. 2023

Health Services Research

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ObjectiveTo determine whether a 6‐ or 12‐month look‐back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health.Study DesignCross‐sectional survey of respondents randomized to 6‐ or 12‐month look‐back period.Data Sources and Study SettingOnline survey with a convenience sample of Veterans in June and July 2021.Data Collection/Extraction MethodsVeteran volunteers were recruited by email to complete a survey assessing social risks, including financial strain, adult caregiving, childcare, food insecurity, housing, transportation, internet access, loneliness/isolation, stress, discrimination, and legal issues. Outcomes included self‐reported overall health and mental health. Chi‐squared tests compared the prevalence of reported social risks between 6‐ and 12‐month look‐back periods. Spearman correlations assessed associations among social risks. Bivariate and multivariable logistic regression models estimated associations between social risks and fair/poor overall and mental health.Principal FindingsOf 3418 Veterans contacted, 1063 (31.10%) responded (87.11% male; 85.61% non‐Hispanic White; median age = 70, interquartile range [IQR] = 61–74). Prevalence of most reported social risks did not significantly differ by look‐back period. Most social risks were weakly intercorrelated (median |r| = 0.24, IQR = 0.16‐0.31). Except for legal issues, all social risks were associated with higher odds of fair/poor overall health and mental health in bivariate models. In models containing all significant social risks from bivariate models, adult caregiving and stress remained significant predictors of overall health; food insecurity, housing, loneliness/isolation, and stress remained significant for mental health.ConclusionsSix‐ and 12‐month look‐back periods yielded similar rates of reported social risks. Although most individual social risks are associated with fair/poor overall and mental health, when examined together, only adult caregiving, stress, loneliness/isolation, food, and housing remain significant.

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Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia

Quach

Franzosa

Zhao

et al. 2023

Journal of Gerontological Social Work

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Improving Prediction of Long-Term Care Utilization Through Patient-Reported Measures: Cross-Sectional Analysis of High-Need U.S. Veterans Affairs Patients

Cited by 5 publications

References 50 publications

Association between patient‐reported social and behavioral risks and health care costs in high‐risk Veterans health administration patients

Association between patient‐reported social and behavioral risks and health care costs in high‐risk Veterans health administration patients

Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients

Home and Community-Based Service Use Varies by Health Care Team and Comorbidity Level of Veterans with Dementia

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