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Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study.
BMC Health Serv Res. 2007 Apr 18; 7:56.BH

Abstract

BACKGROUND

To compare VA inpatient and outpatient utilization and expenditures of veterans seeking primary care in community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs) in fiscal years 2000 (FY00) and 2001.

METHODS

The sample included 25,092 patients who obtained primary care exclusively from 108 CBOCs in FY00, 26,936 patients who obtained primary care exclusively from 72 affiliated VAMCs in FY00, and 11,450 "crossover" patients who obtained primary care in CBOCs and VAMCs in FY00. VA utilization and expenditure data were drawn from the VA's system-wide cost accounting system. Veteran demographic characteristics and a 1999 Diagnostic Cost Group risk score were obtained from VA administrative files. Outpatient utilization (primary care, specialty care, mental health, pharmacy, radiology and laboratory) and inpatient utilization were estimated using count data models and expenditures were estimated using one-part or two-part models. The second part of two-part models was estimated using generalized linear regressions.

RESULTS

CBOC patients had a slightly more primary care visits per year than VAMC patients (p < 0.0001), but lower primary care costs (-$71, p < 0.0001). CBOC patients had lower odds of one or more specialty, mental health, ancillary visits and hospital stays per year, and fewer numbers of visits and stays if they had any and lower specialty, mental health, ancillary and inpatient expenditures (all, p < 0.0001). As a result, CBOC patients had lower total outpatient and overall expenditures than VAMC patients (p < 0.0001).

CONCLUSION

CBOCs provided veterans improved access to primary care and other services, but expenditures were contained because CBOC patients who sought health care had fewer visits and hospital stays than comparable VAMC patients. These results suggest a more complex pattern of health care utilization and expenditures by CBOC patients than has been found in prior studies. This study also illustrates that CBOCs continue to be a critical primary care and mental health access point for veterans.

Authors+Show Affiliations

Center for Health Services Research in Primary Care, Durham VA Medical Center, Department of Veterans Affairs, Durham, NC, USA. matt@email.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

17442115

Citation

Maciejewski, Matthew L., et al. "Utilization and Expenditures of Veterans Obtaining Primary Care in Community Clinics and VA Medical Centers: an Observational Cohort Study." BMC Health Services Research, vol. 7, 2007, p. 56.
Maciejewski ML, Perkins M, Li YF, et al. Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Serv Res. 2007;7:56.
Maciejewski, M. L., Perkins, M., Li, Y. F., Chapko, M., Fortney, J. C., & Liu, C. F. (2007). Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. BMC Health Services Research, 7, 56.
Maciejewski ML, et al. Utilization and Expenditures of Veterans Obtaining Primary Care in Community Clinics and VA Medical Centers: an Observational Cohort Study. BMC Health Serv Res. 2007 Apr 18;7:56. PubMed PMID: 17442115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study. AU - Maciejewski,Matthew L, AU - Perkins,Mark, AU - Li,Yu-Fang, AU - Chapko,Michael, AU - Fortney,John C, AU - Liu,Chuan-Fen, Y1 - 2007/04/18/ PY - 2006/11/08/received PY - 2007/04/18/accepted PY - 2007/4/20/pubmed PY - 2007/5/9/medline PY - 2007/4/20/entrez SP - 56 EP - 56 JF - BMC health services research JO - BMC Health Serv Res VL - 7 N2 - BACKGROUND: To compare VA inpatient and outpatient utilization and expenditures of veterans seeking primary care in community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs) in fiscal years 2000 (FY00) and 2001. METHODS: The sample included 25,092 patients who obtained primary care exclusively from 108 CBOCs in FY00, 26,936 patients who obtained primary care exclusively from 72 affiliated VAMCs in FY00, and 11,450 "crossover" patients who obtained primary care in CBOCs and VAMCs in FY00. VA utilization and expenditure data were drawn from the VA's system-wide cost accounting system. Veteran demographic characteristics and a 1999 Diagnostic Cost Group risk score were obtained from VA administrative files. Outpatient utilization (primary care, specialty care, mental health, pharmacy, radiology and laboratory) and inpatient utilization were estimated using count data models and expenditures were estimated using one-part or two-part models. The second part of two-part models was estimated using generalized linear regressions. RESULTS: CBOC patients had a slightly more primary care visits per year than VAMC patients (p < 0.0001), but lower primary care costs (-$71, p < 0.0001). CBOC patients had lower odds of one or more specialty, mental health, ancillary visits and hospital stays per year, and fewer numbers of visits and stays if they had any and lower specialty, mental health, ancillary and inpatient expenditures (all, p < 0.0001). As a result, CBOC patients had lower total outpatient and overall expenditures than VAMC patients (p < 0.0001). CONCLUSION: CBOCs provided veterans improved access to primary care and other services, but expenditures were contained because CBOC patients who sought health care had fewer visits and hospital stays than comparable VAMC patients. These results suggest a more complex pattern of health care utilization and expenditures by CBOC patients than has been found in prior studies. This study also illustrates that CBOCs continue to be a critical primary care and mental health access point for veterans. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/17442115/Utilization_and_expenditures_of_veterans_obtaining_primary_care_in_community_clinics_and_VA_medical_centers:_an_observational_cohort_study_ L2 - https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-7-56 DB - PRIME DP - Unbound Medicine ER -