Authors: Thomas R Radomski Xinhua Zhao Carolyn T Thorpe Joshua M Thorpe Chester B Good Maria K Mor Michael J Fine Walid F Gellad
Publish Date: 2016/02/22
Volume: 31, Issue: 5, Pages: 524-531
Abstract
Many Veterans treated within the VA Healthcare System VA are also enrolled in feeforservice FFS Medicare and receive treatment outside the VA Prior research has not accounted for the multiple ways that Veterans receive services across healthcare systemsUsing latent class analysis we identified classes of Veterans based upon their probability of using VA and Medicare diabetes care services including patient visits laboratory tests glucose test strips and medications We compared the amount of healthcare use between classes and identified factors associated with class membership using multinomial regressionWe identified four distinct latent classes class 1 539 had high probabilities of VA use and low probabilities of Medicare use classes 2 172 3 218 and 4 70 had high probabilities of VA and Medicare use but differed in their Medicare services used For example Veterans in class 3 received test strips exclusively through Medicare while Veterans in class 4 were reliant on Medicare for medications Living ≥ 40 miles from a VA predicted membership in classes 3 OR 11 CI 106–115 and 4 OR 111 CI 104–118 while Medicaid eligibility predicted membership in class 4 OR 430 CI 410–451Veterans with diabetes can be grouped into four distinct classes of dual health system use representing a novel way to characterize how patients use multiple services across healthcare systems This classification has applications for identifying patients facing differential risk from care fragmentation
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