Use of Medicare and DOD data for improving VA race data quality

Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital (151H), 5000 South 5th Ave, Bldg 1B260, Hines, IL 60141-5151, USA.
The Journal of Rehabilitation Research and Development (Impact Factor: 1.43). 01/2010; 47(8):781-95. DOI: 10.1682/JRRD.2009.08.0122
Source: PubMed


We evaluated the improvement in Department of Veterans Affairs (VA) race data completeness that could be achieved by linking VA data with data from Medicare and the Department of Defense (DOD) and examined agreement in values across the data sources. After linking VA with Medicare and DOD records for a 10% sample of VA patients, we calculated the percentage for which race could be identified in those sources. To evaluate race agreement, we calculated sensitivities, specificities, positive predictive values (PPVs), negative predictive values, and kappa statistics. Adding Medicare (and DOD) data improved race data completeness from 48% to 76%. Among older patients (≥65 years), adding Medicare data improved data completeness to nearly 100%. Among younger patients (<65 years), combining Medicare and DOD data improved completeness to 75%, 18 percentage points beyond that achieved with Medicare data alone. PPVs for white and African-American categories were 98.6 and 94.7, respectively, in Medicare and 97.0 and 96.5, respectively, in DOD data using VA self-reported race as the gold standard. PPVs for the non-African-American minority groups were lower, ranging from 30.5 to 48.2. Kappa statistics reflected these patterns. Supplementing VA with Medicare and DOD data improves VA race data completeness substantially. More study is needed to understand poor rates of agreement between VA and external sources in identifying non-African-American minority individuals.

Download full-text


Available from: Denise M Hynes
  • Source
    • "Equity in the provision of care is a primary goal of the Veterans Health Administration (VHA). The VHA treats a large, disadvantaged patient population selected from among US veterans of military service, including approximately 25–30% non-white veterans [9, 10], with uncertainty arising from missing data. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine equity in one aspect of care provision in the Veterans Health Administration, this study analyzed factors associated with receipt of coronary artery bypass graft (CABG), vascular, hip/knee, or digestive system surgeries during FY2006–2009. A random sample of patients () included 9% with depression, 17% African-American patients, 5% Hispanics, and 5% women. In the four-year followup, 18,334 patients (6%) experienced surgery: 3,109 hip/knee, 3,755 digestive, 1,899 CABG, and 11,330 vascular operations. Patients with preexisting depression were less likely to have surgery than nondepressed patients (4% versus 6%). In covariate-adjusted analyses, minority patients were slightly less likely to receive vascular operations compared to white patients (Hispanic , ; African-American , ) but more likely to undergo digestive system procedures. Some race-/ethnicity-related disparities of care for cardiovascular disease may persist for veterans using the VHA.
    Full-text · Article · Oct 2011 · Depression research and treatment
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Department of Veterans Affairs (VA) provides nationwide access, lifetime coverage, and an integrated care structure to its enrollees. Those key aspects of VA healthcare-together with data contained in VA&apos;s electronic information systems supporting over eight million veterans-provide unique opportunities to study processes, outcomes, and costs of care. Recently, for example, VA data have been used to study outcomes associated with acute postoperative inpatient rehabilitation and care in specialized rehabilitation bed units after lower-limb amputation [1-2], medication adherence and relapse among patients discharged from a VA posttraumatic stress disorder (PTSD) treatment program [3], the provision and costs of assistive technology devices to veterans after stroke [4], and use of mental health services by veterans disabled by auditory disorders [5].
    No preview · Article · Jan 2010 · The Journal of Rehabilitation Research and Development
  • [Show abstract] [Hide abstract]
    ABSTRACT: In 2007, growing concerns about adverse impacts of erythropoiesis-stimulating agents (ESAs) in cancer patients led to an FDA-mandated black box warning on product labeling, publication of revised clinical guidelines, and a Medicare coverage decision limiting ESA coverage. We examined ESA therapy in lung and colon cancer patients receiving chemotherapy in the VA from 2002 to 2008 to ascertain trends in and predictors of ESA use. A retrospective study employed national VA databases to "observe" treatment for a 12-month period following diagnosis. Multivariable logistic regression analyses evaluated changes in ESA use following the FDA-mandated black box warning in March 2007 and examined trends in ESA administration between 2002 and 2008. Among 17,014 lung and 4,225 colon cancer patients, those treated after the March 2007 FDA decision had 65% (lung OR 0.35, CI(95%) 0.30-0.42) and 53% (colon OR 0.47, CI(95%) 0.36-0.63) reduced odds of ESA treatment compared to those treated before. Declines in predicted probabilities of ESA use began in 2006. The magnitude of the declines differed across age groups among colon patients (p = 0.01) and levels of hemoglobin among lung cancer patients (p = 0.04). Use of ESA treatment for anemia in VA cancer care declined markedly after 2005, well before the 2007 changes in product labeling and clinical guidelines. This suggests that earlier dissemination of research results had marked impacts on practice patterns with these agents.
    No preview · Article · Sep 2011 · Supportive Care in Cancer
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.