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Lower comorbidity scores and severity levels in Veterans Health Administration hospitals: a cross-sectional study.
- Source :
-
BMC health services research [BMC Health Serv Res] 2024 May 08; Vol. 24 (1), pp. 601. Date of Electronic Publication: 2024 May 08. - Publication Year :
- 2024
-
Abstract
- Background: Previous studies found that documentation of comorbidities differed when Veterans received care within versus outside Veterans Health Administration (VHA). Changes to medical center funding, increased attention to performance reporting, and expansion of Clinical Documentation Improvement programs, however, may have caused coding in VHA to change.<br />Methods: Using repeated cross-sectional data, we compared Elixhauser-van Walraven scores and Medicare Severity Diagnosis Related Group (DRG) severity levels for Veterans' admissions across settings and payers over time, utilizing a linkage of VHA and all-payer discharge data for 2012-2017 in seven US states. To minimize selection bias, we analyzed records for Veterans admitted to both VHA and non-VHA hospitals in the same year. Using generalized linear models, we adjusted for patient and hospital characteristics.<br />Results: Following adjustment, VHA admissions consistently had the lowest predicted mean comorbidity scores (4.44 (95% CI 4.34-4.55)) and lowest probability of using the most severe DRG (22.1% (95% CI 21.4%-22.8%)). In contrast, Medicare-covered admissions had the highest predicted mean comorbidity score (5.71 (95% CI 5.56-5.85)) and highest probability of using the top DRG (35.3% (95% CI 34.2%-36.4%)).<br />Conclusions: More effective strategies may be needed to improve VHA documentation, and current risk-adjusted comparisons should account for differences in coding intensity.<br /> (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
- Subjects :
- Humans
Cross-Sectional Studies
United States epidemiology
Male
Female
Aged
Middle Aged
Diagnosis-Related Groups statistics & numerical data
United States Department of Veterans Affairs statistics & numerical data
Medicare statistics & numerical data
Aged, 80 and over
Veterans statistics & numerical data
Comorbidity
Hospitals, Veterans statistics & numerical data
Severity of Illness Index
Subjects
Details
- Language :
- English
- ISSN :
- 1472-6963
- Volume :
- 24
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC health services research
- Publication Type :
- Academic Journal
- Accession number :
- 38714970
- Full Text :
- https://doi.org/10.1186/s12913-024-11063-3