Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Creator
  • Wang, Virginia
    • Other Affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, 27705, USA
  • Maciejewski, Matthew L
    • Other Affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, 27705, USA
  • Patel, Uptal D
    • Other Affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA; Division of Nephrology, Department of Medicine, Duke University, Durham, NC, 27705, USA
  • Stechuchak, Karen M
    • Other Affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA
  • Hynes, Denise M
    • Other Affiliation: VA Information Resource Center, Hines VA Hospital, Riverside, IL, 60546, USA; Center for Management of Complex Chronic Care, Hines VA Hospital, Riverside, IL, 60546, USA; Department of Medicine, University of Illinois-Chicago College of Medicine, Chicago, IL, 60612, USA
  • Weinberger, Morris
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
    • Other Affiliation: Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA
Abstract
  • Abstract Background Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers. Methods We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both (“dual”) settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date. Results Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis. Conclusions VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.
Date of publication
DOI
Identifier
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Virginia Wang et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Health Services Research
Journal volume
  • 13
Journal issue
  • 1
Page start
  • 26
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1472-6963
Bibliographic citation
  • BMC Health Services Research. 2013 Jan 18;13(1):26
Publisher
  • BioMed Central Ltd
Access right
  • Open Access
Date uploaded
  • January 30, 2013

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details 1472-6963-13-26.pdf 2019-05-07 Public Download
file details 1472-6963-13-26.xml 2019-05-07 Public Download