Geographic variations in utilization rates in veterans affairs hospitals and clinics

Carol M. Ashton, Nancy J. Petersen, Julianne Souchek, Terri J. Menke, Yu Hong-Jen, Kenneth Pietz, Marsha L. Eigenbrodt, Galen Barbour, Kenneth W Kizer, Nelda P. Wray

Research output: Contribution to journalArticle

195 Citations (Scopus)

Abstract

Background: In the United States, geographic variation in hospital use is common. It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians. Thus, it might be less likely to have geographic variations. Methods: We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression). We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks. Results: We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied. Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease (ranging from a factor of 2.7 to a factor of 3.1) during a given year and smallest among patients with angina (ranging from a factor of 1.5 to a factor of 2.1). Levels of hospital use were highest in the Northeast and lowest in the West. The variation in the rates of clinic visits for principal medical care among the networks ranged from a factor of approximately 1.6 to a factor of 4.0; variations in the rates were greatest among patients with chronic renal failure and smallest among patients with congestive heart failure. There was no clear geographic pattern in the rates of outpatient-clinic use. Conclusions: There are significant geographic variations in the use of hospital and outpatient services in the VA health care system. Because VA physicians are unable to increase their income by changing their patterns of practice, our findings suggest that their practice styles are similar to those of other physicians in their geographic regions.

Original languageEnglish (US)
Pages (from-to)32-39
Number of pages8
JournalNew England Journal of Medicine
Volume340
Issue number1
DOIs
StatePublished - Jan 7 1999
Externally publishedYes

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Veterans Hospitals
Ambulatory Care
Veterans
Delivery of Health Care
Physicians
Chronic Obstructive Pulmonary Disease
Chronic Kidney Failure
Heart Failure
Veterans Health
Private Sector
Ambulatory Care Facilities
Bipolar Disorder
Length of Stay
Pneumonia
Databases
Depression

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ashton, C. M., Petersen, N. J., Souchek, J., Menke, T. J., Hong-Jen, Y., Pietz, K., ... Wray, N. P. (1999). Geographic variations in utilization rates in veterans affairs hospitals and clinics. New England Journal of Medicine, 340(1), 32-39. https://doi.org/10.1056/NEJM199901073400106

Geographic variations in utilization rates in veterans affairs hospitals and clinics. / Ashton, Carol M.; Petersen, Nancy J.; Souchek, Julianne; Menke, Terri J.; Hong-Jen, Yu; Pietz, Kenneth; Eigenbrodt, Marsha L.; Barbour, Galen; Kizer, Kenneth W; Wray, Nelda P.

In: New England Journal of Medicine, Vol. 340, No. 1, 07.01.1999, p. 32-39.

Research output: Contribution to journalArticle

Ashton, CM, Petersen, NJ, Souchek, J, Menke, TJ, Hong-Jen, Y, Pietz, K, Eigenbrodt, ML, Barbour, G, Kizer, KW & Wray, NP 1999, 'Geographic variations in utilization rates in veterans affairs hospitals and clinics', New England Journal of Medicine, vol. 340, no. 1, pp. 32-39. https://doi.org/10.1056/NEJM199901073400106
Ashton, Carol M. ; Petersen, Nancy J. ; Souchek, Julianne ; Menke, Terri J. ; Hong-Jen, Yu ; Pietz, Kenneth ; Eigenbrodt, Marsha L. ; Barbour, Galen ; Kizer, Kenneth W ; Wray, Nelda P. / Geographic variations in utilization rates in veterans affairs hospitals and clinics. In: New England Journal of Medicine. 1999 ; Vol. 340, No. 1. pp. 32-39.
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abstract = "Background: In the United States, geographic variation in hospital use is common. It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians. Thus, it might be less likely to have geographic variations. Methods: We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression). We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks. Results: We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied. Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease (ranging from a factor of 2.7 to a factor of 3.1) during a given year and smallest among patients with angina (ranging from a factor of 1.5 to a factor of 2.1). Levels of hospital use were highest in the Northeast and lowest in the West. The variation in the rates of clinic visits for principal medical care among the networks ranged from a factor of approximately 1.6 to a factor of 4.0; variations in the rates were greatest among patients with chronic renal failure and smallest among patients with congestive heart failure. There was no clear geographic pattern in the rates of outpatient-clinic use. Conclusions: There are significant geographic variations in the use of hospital and outpatient services in the VA health care system. Because VA physicians are unable to increase their income by changing their patterns of practice, our findings suggest that their practice styles are similar to those of other physicians in their geographic regions.",
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AU - Petersen, Nancy J.

AU - Souchek, Julianne

AU - Menke, Terri J.

AU - Hong-Jen, Yu

AU - Pietz, Kenneth

AU - Eigenbrodt, Marsha L.

AU - Barbour, Galen

AU - Kizer, Kenneth W

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N2 - Background: In the United States, geographic variation in hospital use is common. It is uncertain whether there are similar geographic variations in the health care system of the Department of Veterans Affairs (VA), which differs from the private sector because it predominantly serves men with annual incomes below $20,000, has a central system of administration, and uses salaried physicians. Thus, it might be less likely to have geographic variations. Methods: We used VA data bases to obtain information on patients treated for eight diseases (chronic obstructive pulmonary disease, pneumonia, congestive heart failure, angina, diabetes, chronic renal failure, bipolar disorder, and major depression). We analyzed their use of hospital and outpatient services by assessing the risk-adjusted numbers of hospital days (the average number of days a patient spent in the hospital per 12 months of follow-up, regardless of the number of hospital stays), hospital-discharge rates, and clinic-visit rates from 1991 through 1995 for the entire system and within the 22 geographically based health care networks. Results: We found substantial geographic variation in hospital use for all eight cohorts of patients and all the years studied. Variations in the numbers of hospital days per person-year among the networks were greatest among patients with chronic obstructive pulmonary disease (ranging from a factor of 2.7 to a factor of 3.1) during a given year and smallest among patients with angina (ranging from a factor of 1.5 to a factor of 2.1). Levels of hospital use were highest in the Northeast and lowest in the West. The variation in the rates of clinic visits for principal medical care among the networks ranged from a factor of approximately 1.6 to a factor of 4.0; variations in the rates were greatest among patients with chronic renal failure and smallest among patients with congestive heart failure. There was no clear geographic pattern in the rates of outpatient-clinic use. Conclusions: There are significant geographic variations in the use of hospital and outpatient services in the VA health care system. Because VA physicians are unable to increase their income by changing their patterns of practice, our findings suggest that their practice styles are similar to those of other physicians in their geographic regions.

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