Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

Augustine, Matthew R.; Mason, Tanieka; Baim-Lance, Abigail; Boockvar, Kenneth S.

doi:10.3122/jabfm.2021.02.200332

Cited by 5 publications

(3 citation statements)

References 44 publications

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“…minority veterans are likely to use non-VA of health care. 28 Another study examining VA and Medicare claims data noted greater utilization of VA services among Black veterans. The underlying priority score was the strongest predictor VA service utilization, suggesting that economic factors may play a large role in the decision to use VA services.…”

Section: Discussionmentioning

confidence: 99%

“…The higher percentage of Hispanic/Latinos seeking VHA care in our analysis compared to other groups may be influenced partially by our inability to study VHA care received in the community (at non‐VHA facilities). Prior studies examining older urban veterans noted that non‐minority veterans are more likely to use non‐VA sources of health care 28 . Another study examining VA and Medicare claims data noted greater utilization of VA services among Black veterans.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Health care utilization of Hispanic/Latino veterans with epilepsy: A national population‐based study

Tantillo,

Sullivan‐Baca,

Rehman

et al. 2024

Epilepsia

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ObjectiveHispanic/Latino people with epilepsy are a growing population that has been understudied in clinical epilepsy research. U.S. veterans are at a higher risk of epilepsy due to greater exposures including traumatic brain injury. Hispanic/Latino Veterans with Epilepsy (HL‐VWEs) represent a growing population; however the treatment utilization patterns of this population have been vastly understudied.MethodsHL‐VWE were identified from administrative databases during fiscal year 2019. Variables compared between Hispanic and non‐Hispanic VWEs included demographics, rurality, service era, utilization of clinical services/investigations, and service‐connected injury. Chi‐square and Student's t tests were used for comparisons.ResultsAmong 56 556 VWEs, 3247 (5.7%) were HL. HL‐VWEs were younger (59.2 vs 63.2 years; p < .01) and more commonly urban‐dwelling (81.6% vs 63.2%, p < .01) compared to non–HL‐VWEs. They were also more likely to have served in recent missions such as the Persian Gulf War and post‐ 9/11 wars (p < .01). HL‐VWEs had a higher utilization of all neurology services examined including neurology clinic visits, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, electroencephalography (EEG), epilepsy monitoring, and comprehensive epilepsy care (p < .01 for all). HL‐VWEs were more likely to visit an emergency room or have seizure‐related hospitalizations (p < .01). HL‐VWEs were more likely to have a service‐connected disability greater or equal to 50% (p < .01).SignificanceThis study is one of the largest cohorts examining HL‐VWEs. We found higher utilization of services in neurology, epilepsy, and neuroimaging by HL‐VWEs. HL‐VWE are younger, more commonly urban‐dwelling, and more likely to have served during recent combat periods and have higher amounts of service‐connected disability. Given that the proportion of Hispanic veterans is projected to rise over time, more research is needed to provide the best interventions and mitigate the long‐term impact of epilepsy on this diverse patient group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health care utilization of Hispanic/Latino veterans with epilepsy: A national population‐based study

Tantillo,

Sullivan‐Baca,

Rehman

et al. 2024

Epilepsia

View full text Add to dashboard Cite

show abstract

“…6 Veterans with VA care may go to non-VA providers electively, or nonelectively because of an acute condition that requires treatment at the nearest hospital. 7 VA providers are often not aware of non-VA encounters until notified by non-VA providers, patients, or families. 8 This is likely one reason dual VA and non-VA system use is associated with higher hospital admission and readmission rates and greater adverse events, 9,10 in particular for older veterans.…”

Section: Introductionmentioning

confidence: 99%

Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial

et al. 2022

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BACKGROUND: Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. OBJECTIVE: To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. DESIGN: Cluster-randomized controlled trial with group assignment by primary care team. PATIENTS: Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. INTERVENTIONS: For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. MEASURES: Primary outcome: 90-day hospital admission or readmission. Secondary outcomes: emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. KEY RESULTS: A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI − 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. CONCLUSIONS:A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.

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Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention

Koufacos

May

Judon

et al. 2021

Journal of Gerontological Social Work

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Reasons Older Veterans Use the Veterans Health Administration and Non-VHA Care in an Urban Environment

Cited by 5 publications

References 44 publications

Health care utilization of Hispanic/Latino veterans with epilepsy: A national population‐based study

Health care utilization of Hispanic/Latino veterans with epilepsy: A national population‐based study

Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial

Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention

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