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Comparing the Characteristics, Utilization, Efficiency, and Outcomes of VA and Non-VA Inpatient Care Provided to VA Enrollees: A Case Study in New York

Weeks, William B. MD, MBA*†‡; West, Alan N. PhD*; Wallace, Amy E. MD, MPH*†‡; Fisher, Elliott S. MD, MPH*†§

doi: 10.1097/MLR.0b013e31817d92e1
Original Article

Objective: To compare the characteristics, utilization, and outcomes of Veterans Health Administration (VA) and non-VA inpatient care provided to VA enrollees in New York.

Methods: Using VA and New York State administrative and clinical databases, we conducted a retrospective study examining 110,716 residents of New York State who were enrolled in the VA and had 266,869 inpatient admissions in VA and non-VA hospitals in New York. For each admission, we determined the system of care used (VA or non-VA), patient demographics, and characteristics of the admission, and we calculated VA patients’ relative reliance on the VA for inpatient care. For each Major Diagnostic Category (MDC), we examined reliance, patient characteristics, and lengths-of-stay for 2 groups: veterans who were younger than age 65 and those age 65 or older.

Results: Fifty-three percent of younger patients’ inpatient admissions were in the VA, whereas 32% of older patients’ were; however, relative reliance on the VA varied dramatically across the 19 MDCs examined. Across age groups, patients admitted to VA hospitals were younger, less likely to be white, and less likely to live in a rural setting. Those using VA hospitals had lower Charlson scores and received less complex care. For both age groups and across all MDCs, admissions to VA hospitals had substantially higher diagnosis related group-specific observed-to-expected lengths-of-stay.

Conclusions: Younger and older veterans use VA and non-VA hospitals differently for inpatient services. Comprehensive inpatient datasets could inform planners about VA's service market and VA managers about achievable performance benchmarks that are relevant to VA's service population.

From the *VA Outcomes Group Research Enhancement Award Program, White River Junction VA Medical Center, White River Junction, Vermont; †The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire; ‡Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire; and §Department of Internal Medicine, Dartmouth Medical School, Hanover, New Hampshire.

Supported in part by VA Health Services Research and Development Grants REA 03-098 and IIR 04-236.

The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the US government.

Dr. Weeks had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Reprints: William B. Weeks, MD, MBA, VA Medical Center (11Q), 215 N. Main Street, White River Junction, VT 05009. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.