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BACKGROUND/RATIONALE:
Multiple sclerosis (MS) - a chronic, deteriorating neurological condition - affects 400,000 Americans and potentially 30,000 veterans using VHA care during their family and career development years. VHA established MS Centers of Excellence (MS CoE) in 2002, mandating improvement of veterans' MS care. Without a cure, MS care is symptom-management and rehabilitation-focused, delivered primarily in outpatient settings with medical management though "Disease Modifying Therapies (DMTs)". Complex care patterns result from uncertainty about: diagnosis, treatment and maintenance. In nearly 25% of veterans with MS, Medicare coverage, (gained with SSDI disability status, after a 2-year application following unemployment), offers local alternatives or augmentation to VHA-based care, but may introduce problems of discontinuity in chronic care.
OBJECTIVE(S):
Our short-term goal is to answer, "Does dual-eligibility (VHA & Medicare) improve quality, or threaten patient safety?" Our long-term goal is to derive credible, patient- and system-level outcomes from extant and patient response data to examine MS care delivery. This requires linking VHA and Medicare databases and survey data, detecting differences in outcomes related to dual-eligibility or patterns of care, and using findings to optimize veterans' care.
METHODS:
This 2.5-year study, with primary data collection and a retrospective, longitudinal extant database analysis will examine access, quality and patient safety through VHA and Medicare extant data and patient self-report. We will determine if veterans' use of Medicare services is driven by: convenience or augmented healthcare. Merging Medicare and VHA data (1998 to 2005), with a national survey of MS-veterans will support longitudinal regression modeling of consumption patterns, controlling for: Medicare eligibility, distance to VHA care, comorbidity and demographics (age, gender, income). A series of "two-part" models (one equation estimating probability of use, and the other total costs) is planned for total VHA and Medicare care, and the components of inpatient, outpatient care and pharmacy care.
Hypotheses focus on dual-eligibles among nearly 18,000 veterans of all ages. Analyses will control confounders of: comorbidities, demographics and self-reported disability, MS Sub-type, and duration of MS.
1.Dual-eligibility (VHA and Medicare) increases the probability of any healthcare use and the total consumption annually, in veterans with MS.
2.As disability or distance from the "nearest" VHA Medical Center increases, inpatient care from Medicare-covered, non-VHA-providers increases.
3.As disability or distances from any VHA outpatient clinic increases, outpatient care from Medicare-covered, non-VHA-providers increases.
4.Preventable admissions will be lower among veterans with only VHA-based care, as compared to veterans with both VHA and Medicare covered care.
5.In veterans on Disease Modifying Therapies (DMTs), side effects will be higher among veterans with VHA and Medicare covered care, compared to veterans with only VHA-based care.
FINDINGS/RESULTS:
Enter text here.
IMPACT:
Our study will allow VHA and MS CoEs to assess whether VHA's telemedicine and care coordination services should include private sector Medicare-accepting providers to optimize care for veterans with MS. This study will indicate if Medicare policy changes which restrict community-based rehabilitation will further exacerbate continuity of care in MS-veterans. Study findings will modify VHA guidelines for improved MS care.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Resource Use and Cost
Keywords:
Chronic disease (other & unspecified), Quality assessment, Neural Mechanisms of Brain Disorders
MeSH Terms:
none
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