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BACKGROUND/RATIONALE:
Diabetes is a chronic disease that is the major cause of adult blindness, end stage renal disease, cardiovascular disease and amputations. Its direct medical costs in US are estimated as $92 billion in 2002. Diabetes also has a significant impact on the healthcare of veterans as well as costs to the VHA. However, no studies have evaluated utilization and costs for VHA patients with diabetes or pre-diabetes over time, or how health care and costs for VHA patients with diabetes are attributed to microvascular, macrovascular, metabolic, and all other medical conditions. In addition, the impact of personal level factors such as diabetes duration, obesity, mental health conditions, social support, health behaviors on healthcare utilization and costs incurred by VHA patients with diabetes is not known. Furthermore, no VA studies have assessed the non-VHA cost incurred by VHA patients with diabetes and cost sharing between VHA and Medicare.
Aims and Objective
OBJECTIVE(S):
Aim 1: Examine the longitudinal trends in utilization and its associated cost for VHA patients with diabetes or pre-diabetes using the combined VHA and Medicare data; assess the association between diabetes duration, obesity, mental health conditions and utilization/cost, controlling for other personal and system factors.
We will examine inpatient, outpatient and pharmaceutical utilization trends for all VHA patients with diabetes or pre-diabetes. Within inpatient and outpatient care, we will examine microvascular conditions (lower extremity complications, chronic kidney disease and proliferative retinopathy/laser therapy), macrovascular conditions (cardiovascular disease, stroke, peripheral vascular disease), metabolic (hyperosmolar non-ketotic diabetic coma, ketoacidosis, hypoglycemia, and uncontrolled diabetes) and all other medical conditions. We will also examine pharmacy cost associated with primary and secondary prevention and treatment of macrovascular conditions (anti-hypertensive/cardiovascular and antilipid medications) and anti-glycemic medications and supplies within pharmacy use.
Aim 2: Among VHA-Medicare dual enrollees with diabetes, evaluate the longitudinal trends in: 1) Medicare HMO/FFS enrollment; 2) VHA utilization/cost and Medicare FFS utilization/cost; and 3) reliance on VHA and Medicare.
Aim 3: Among VHA patients with and without diabetes, examine the differences in: 1) the longitudinal time trend in utilization and its associated cost; 2) the association between obesity and utilization/cost; and 3) the reliance on VHA and Medicare.
Methods:
This longitudinal study will follow the study cohort (1999 LVHS respondents with diabetes, pre-diabetes or non-diabetes) for a maximum of seven years. We will create a rich database that links the Large Veterans Health Survey (LVHS) to VHA and Medicare administrative data. To accomplish the objectives of the study, we will use multivariable and robust regression techniques to control for correlated data due to clustering and repeated observations.
METHODS:
We will analyze longitudinal trends and predictors of utilization and cost for patients with diabetes or pre-diabetes over the period of FY1999-FY2005. In addition, we will assess the dynamic enrollment in Medicare HMO versus FFS (HMO/FFS) among VHA-Medicare dual enrollees with diabetes; evaluate the longitudinal trends of VHA and Medicare utilization and cost and reliance by the VHA-Medicare dual enrollees with Medicare FFS. Finally, we will compare the differences in time trend of utilization/cost, the impact of obesity on utilization/cost, and reliance on VA/Medicare among patients with diabetes and without diabetes.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
Understanding the longitudinal trending of total (VA and Medicare FFS) costs and of the drivers of growth in costs can better inform future utilization and cost projections. Understanding the importance of Medicare in contributing to the total costs of diabetes among veterans and factors that affect the care shifting is vital to administrators and policy makers. Our results could inform future discussions on care coordination as well as cost sharing between two Federal programs.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Epidemiology, Resource Use and Cost
Keywords:
Diabetes, Utilization patterns
MeSH Terms:
none
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