Published Online
on December 28, 2006

A more recent version of this article appeared on February 1, 2007

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Submitted on June 30, 2006
Revised on August 7, 2006
Accepted on September 13, 2006

Multiple System Utilization and Mortality for Veterans With Stroke

Huanguang Jia PhD^*; Yu Zheng MS; Dean M. Reker PhD; Diane C. Cowper PhD; Samuel S. Wu PhD; W. Bruce Vogel PhD; Gail C. Young MA; and Pamela W. Duncan PhD

From Department of Veterans Affairs Rehabilitation Outcomes Research Center (H.J., Y.Z., D.M.R., D.C.C., S.S.W., W.B.V., G.C.Y., P.W.D.), Gainesville, Fla; Division of Biostatistics (Y.Z., S.S.W.), University of Florida College of Medicine, Gainesville, Fla; Department of Veterans Affairs Medical Center (D.M.R.), Kansas City, Mo and Health, Policy and Management, University of Kansas Medical Center, Kansas City, Ks; Department of Epidemiology and Health Policy Research (W.B.V.), University of Florida College of Medicine, Gainesville, Fla; Department of Health Education and Behavior (G.C.Y.), University of Florida College of Health and Human Performance, Gainesville, Fla; Institute of Aging (P.W.D.), University of Florida, Gainesville, Fla.

^* To whom correspondence should be addressed. E-mail: Huanguang.Jia{at}med.va.gov.

Background and Purpose--Many Veteran Health Administration (VHA) enrollees receive health services outside the VHA system. However, limited information is available about poststroke utilization and mortality by veterans who used multiple sources of health care. This study assessed the likelihood of 12-month poststroke rehospitalization and mortality of veterans who used VHA only versus those who used multiple sources of care.

Methods--Our retrospective observational study examined veterans living in Florida and diagnosed with acute stroke. We categorized users into 4 groups: VHA-only, VHA-Medicare, VHA-Medicaid, and VHA-Medicare-Medicaid based on their use of each health care program. Logistic regression models were fitted for 12-month poststroke general rehospitalization, recurrent stroke readmission, and mortality, adjusting for sociodemographic and clinical factors.

Results--The sample consisted of 29% VHA-only users, 61% VHA-Medicare users, 3% VHA-Medicaid users, and 7% VHA-Medicare-Medicaid triple users. Compared with the VHA-only users, multiple system users were significantly more likely to be rehospitalized for any cause and for recurrent stroke 12-months postindex. Mortality outcomes depended on when the outcome was measured; at the index admission date, we found no significant difference in mortality across the user groups; at the index discharge date, the VHA-only users was less likely to die within the first 12 months than the users of the 2 dual groups (VHA-Medicare and VHA-Medicaid).

Conclusions--Multiple health care source use was common among VHA enrollees with acute stroke in Florida. Multiple system users were more likely to be rehospitalized and the mortality outcomes were dependent on when the outcome was measured.

Key words: health services research • mortality • utilization

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