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Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis.

Publication ,  Journal Article
Wang, V; Coffman, CJ; Stechuchak, KM; Berkowitz, TSZ; Hebert, PL; Edelman, D; O'Hare, AM; Weidenbacher, HJ; Maciejewski, ML
Published in: Health Serv Res
December 2018

OBJECTIVE: Growing demand for VA dialysis exceeds its supply and travel distances prohibit many Veterans from receiving dialysis in a VA facility, leading to increased use of dialysis from non-VA providers. This study compared utilization and hospitalization outcomes among Veterans receiving chronic dialysis in VA and non-VA settings in 2008-2013. DATA SOURCES: VA, Medicare, and national disease registry data. STUDY DESIGN: National cohort of 27,301 Veterans initiating dialysis, observed for a period of 2 years after treatment initiation. We used multinomial logistic regression to examine associations between patient characteristics and dialysis use in VA, non-VA community settings via VA Purchased Care (VA-PC), community settings via Medicare, or Dual settings. Zero-inflated negative binomial regression was used to compare risk of hospitalization and days spent in the hospital across dialysis settings. PRINCIPAL FINDINGS: Sixty-seven percent of Veterans obtained community-based dialysis exclusively via Medicare, 11 percent in the community via VA-PC, 4 percent in VA, and 18 percent in Dual settings. Financial and geographic access factors were important predictors of dialysis setting, but days spent in the hospital and risk of hospitalization did not differ meaningfully across settings. CONCLUSIONS: Most Veterans obtained dialysis in the community. Dialysis setting appeared to have little impact on risk of hospitalization among Veterans.

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Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2018

Volume

53 Suppl 3

Issue

Suppl Suppl 3

Start / End Page

5309 / 5330

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Transportation
  • Socioeconomic Factors
  • Sex Factors
  • Retrospective Studies
  • Renal Dialysis
  • Racial Groups
  • Outpatients
  • Middle Aged
 

Citation

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Wang, V., Coffman, C. J., Stechuchak, K. M., Berkowitz, T. S. Z., Hebert, P. L., Edelman, D., … Maciejewski, M. L. (2018). Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis. Health Serv Res, 53 Suppl 3(Suppl Suppl 3), 5309–5330. https://doi.org/10.1111/1475-6773.13022
Wang, Virginia, Cynthia J. Coffman, Karen M. Stechuchak, Theodore S. Z. Berkowitz, Paul L. Hebert, David Edelman, Ann M. O’Hare, Hollis J. Weidenbacher, and Matthew L. Maciejewski. “Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis.Health Serv Res 53 Suppl 3, no. Suppl Suppl 3 (December 2018): 5309–30. https://doi.org/10.1111/1475-6773.13022.
Wang V, Coffman CJ, Stechuchak KM, Berkowitz TSZ, Hebert PL, Edelman D, et al. Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis. Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5309–30.
Wang, Virginia, et al. “Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis.Health Serv Res, vol. 53 Suppl 3, no. Suppl Suppl 3, Dec. 2018, pp. 5309–30. Pubmed, doi:10.1111/1475-6773.13022.
Wang V, Coffman CJ, Stechuchak KM, Berkowitz TSZ, Hebert PL, Edelman D, O’Hare AM, Weidenbacher HJ, Maciejewski ML. Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis. Health Serv Res. 2018 Dec;53 Suppl 3(Suppl Suppl 3):5309–5330.
Journal cover image

Published In

Health Serv Res

DOI

EISSN

1475-6773

Publication Date

December 2018

Volume

53 Suppl 3

Issue

Suppl Suppl 3

Start / End Page

5309 / 5330

Location

United States

Related Subject Headings

  • United States Department of Veterans Affairs
  • United States
  • Transportation
  • Socioeconomic Factors
  • Sex Factors
  • Retrospective Studies
  • Renal Dialysis
  • Racial Groups
  • Outpatients
  • Middle Aged