Intensity, Characteristics, and Factors Associated With Receipt of Care Coordination Among High-Risk Veterans in the Veterans Health Administration.
Humans
United States
Male
Female
United States Department of Veterans Affairs
/ statistics & numerical data
Retrospective Studies
Middle Aged
Veterans
/ statistics & numerical data
Aged
Adult
Continuity of Patient Care
/ statistics & numerical data
Veterans Health Services
/ statistics & numerical data
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 Aug 2024
01 Aug 2024
Historique:
medline:
5
7
2024
pubmed:
5
7
2024
entrez:
5
7
2024
Statut:
ppublish
Résumé
The Veterans Health Administration (VHA) has initiatives underway to enhance the provision of care coordination (CC), particularly among high-risk Veterans. Yet, evidence detailing the characteristics of and who receives VHA CC is limited. We examined intensity, timing, setting, and factors associated with VHA CC among high-risk Veterans. We conducted a retrospective observational cohort study, following Veterans for 1 year after being identified as high-risk for hospitalization or mortality, to characterize their CC. Demographic and clinical factors predictive of CC were identified via multivariate logistic regression. A total of 1,843,272 VHA-enrolled high-risk Veterans in fiscal years 2019-2021. We measured 5 CC variables during the year after Veterans were identified as high risk: (1) receipt of any service, (2) number of services received, (3) number of days to first service, (4) number of days between services, and (5) type of visit during which services were received. Overall, 31% of high-risk Veterans in the sample received CC during one-year follow-up. Among Veterans who received ≥1 service, a median of 2 [IQR (1, 6)] services were received. Among Veterans who received ≥2 services, there was a median of 26 [IQR (10, 57)] days between services. Most services were received during outpatient psychiatry (46%) or medicine (16%) visits. Veterans' sociodemographic and clinical characteristics were associated with receipt of CC. A minority of Veterans received CC in the year after being identified as high-risk, and there was variation in intensity, timing, and setting of CC. Research is needed to examine the fit between Veterans' CC needs and preferences and VHA CC delivery.
Sections du résumé
BACKGROUND
BACKGROUND
The Veterans Health Administration (VHA) has initiatives underway to enhance the provision of care coordination (CC), particularly among high-risk Veterans. Yet, evidence detailing the characteristics of and who receives VHA CC is limited.
OBJECTIVES
OBJECTIVE
We examined intensity, timing, setting, and factors associated with VHA CC among high-risk Veterans.
RESEARCH DESIGN
METHODS
We conducted a retrospective observational cohort study, following Veterans for 1 year after being identified as high-risk for hospitalization or mortality, to characterize their CC. Demographic and clinical factors predictive of CC were identified via multivariate logistic regression.
SUBJECTS
METHODS
A total of 1,843,272 VHA-enrolled high-risk Veterans in fiscal years 2019-2021.
MEASURES
METHODS
We measured 5 CC variables during the year after Veterans were identified as high risk: (1) receipt of any service, (2) number of services received, (3) number of days to first service, (4) number of days between services, and (5) type of visit during which services were received.
RESULTS
RESULTS
Overall, 31% of high-risk Veterans in the sample received CC during one-year follow-up. Among Veterans who received ≥1 service, a median of 2 [IQR (1, 6)] services were received. Among Veterans who received ≥2 services, there was a median of 26 [IQR (10, 57)] days between services. Most services were received during outpatient psychiatry (46%) or medicine (16%) visits. Veterans' sociodemographic and clinical characteristics were associated with receipt of CC.
CONCLUSIONS
CONCLUSIONS
A minority of Veterans received CC in the year after being identified as high-risk, and there was variation in intensity, timing, and setting of CC. Research is needed to examine the fit between Veterans' CC needs and preferences and VHA CC delivery.
Identifiants
pubmed: 38967995
doi: 10.1097/MLR.0000000000002020
pii: 00005650-202408000-00008
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
549-558Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
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