Women Veterans enrolled in Veterans Affairs (VA) health care almost always use non-VA hospitals for childbirth, making it more likely they will use non-VA hospitals for other needs, as well. We compared VA and non-VA hospitalizations obtained by VA enrollees in seven states from 2004 through 2007 to determine whether women aged 18 to 44 were more likely to use VA or non-VA care for diagnoses in certain major categories, and how this use differed between women who did or did not have any pregnancy/childbirth admissions during the 4 years. We found that women were hospitalized much more in non-VA than in VA hospitals, though they were relatively more likely to use VA hospitals for mental illness, digestive system diseases, and neoplasms than other diagnoses. Women who gave birth during the time interval had very few VA admissions for any diagnosis, and compared to other women they were also less likely to be hospitalized for mental health or cancer, but more likely to be hospitalized for infectious and parasitic diseases. VA hospitals were used more by women who were slightly older, sicker, poorer, and living nearer to them. VA-using women tend to have different and greater medical needs than those having children.
[Show abstract][Hide abstract] ABSTRACT: This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.
The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other aspects of the patient's condition, development of a comorbidity algorithm, and testing on heterogeneous and homogeneous patient groups. Data were drawn from all adult, nonmaternal inpatients from 438 acute care hospitals in California in 1992 (n = 1,779,167). Outcome measures were those commonly available in administrative data: length of stay, hospital charges, and in-hospital death.
A comprehensive set of 30 comorbidity measures was developed. The comorbidities were associated with substantial increases in length of stay, hospital charges, and mortality both for heterogeneous and homogeneous disease groups. Several comorbidities are described that are important predictors of outcomes, yet commonly are not measured. These include mental disorders, drug and alcohol abuse, obesity, coagulopathy, weight loss, and fluid and electrolyte disorders.
The comorbidities had independent effects on outcomes and probably should not be simplified as an index because they affect outcomes differently among different patient groups. The present method addresses some of the limitations of previous measures. It is based on a comprehensive approach to identifying comorbidities and separates them from the primary reason for hospitalization, resulting in an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.
Medical Care 02/1998; 36(1):8-27. DOI:10.1097/00005650-199801000-00004 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The term "rural" suggests many things to many people, such as agricultural landscapes, isolation, small towns, and low population density.However, defining "rural" for health policy and research purposes requires researchers and policy analysts to specify which aspects of rurality are most relevant to the topic at hand and then select an appropriate definition. Rural and urban taxonomies often do not discuss important demographic, cultural, and economic differences across rural places-differences that have major implications for policy and research. Factors such as geographic scale and region also must be considered. Several useful rural taxonomies are discussed and compared in this article. Careful attention to the definition of "rural" is required for effectively targeting policy and research aimed at improving the health of rural Americans.
American Journal of Public Health 08/2005; 95(7):1149-55. DOI:10.2105/AJPH.2004.042432 · 4.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Women veterans are generally less healthy than their nonveteran female counterparts or male veterans. Accumulating evidence suggests there may be barriers to women veterans' access to and use of Veterans Health Administration (VHA) care.
To document perceived and/or actual barriers to care in a nationally representative sample of women veterans and examine associations with VHA use.
Cross-sectional telephone survey.
Women who are current and former users of VHA from VA's National Registry of Women Veterans.
Assessments of perceptions of VHA care, background characteristics, and health service use.
Perceptions of VHA care were most positive regarding facility/physical environment characteristics and physician skill and sensitivity and least positive regarding the availability of needed services and logistics of receiving VHA care (M=0.05 and M=-0.10; M=-0.23 and M=-0.25, respectively). The most salient barrier to the use of VHA care was problems related to ease of use. Moreover, each of the barriers constructs contributed unique variance in VHA health care use above and beyond background characteristics known to differentiate current users from former VHA users (Odds ratio [OR]=4.03 for availability of services; OR=2.63 for physician sensitivity and skill: OR=2.70 for logistics of care; OR=2.30 for facility/physical environment). Few differences in barriers to care and their association with VHA health care use emerged for women with and without service-connected disabilities.
Findings highlight several domains in which VHA decisionmakers can intervene to enhance the care available to women veterans and point to a number of areas for further investigation.
Journal of General Internal Medicine 04/2006; 21 Suppl 3(S3):S19-25. DOI:10.1111/j.1525-1497.2006.00370.x · 3.42 Impact Factor
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