2004. Geographic Differences in VA Queri Diseases
Magdalena Yu, MPH, VA Palo Alto Healthcare System, D Cowper, VA Gainesville Medical Center, M Berger, VA Palo Alto Healthcare System, M Kuebeler, VA Houston HSR&D Center of Excellence, J Kubal, VA Hines Medical Center, L Manheim, Northwestern University

Objectives: The Quality Enhancement Research Initiative (QUERI) currently focuses on nine diseases: congestive heart failure, colorectal cancer, diabetes, HIV/AIDS, ischemic heart disease, psychiatric disorders, spinal-cord injury, stroke, and substance abuse. GIS was used to map the number of patients, their health care utilization, and costs in each VISN for these diseases.

Methods: We identified patients with the QUERI conditions using ICD-9 diagnoses recorded in the inpatient PTF and outpatient events files in fiscal year 2000. Cost data were obtained from HERC inpatient and outpatient cost data sets and VA DSS outpatient pharmacy cost data. We classified patients’ health care costs into four utilization categories. GIS was used to map these data in the 22 VISNs.

Results: Of the 4.4 million veterans enrolled in FY00, 3.3 million (75 percent) had at least one of the nine QUERI conditions and obtained medical care at VA facilities. The number of patients, average annual cost per person and resource utilization significantly varied across VISNs.

Conclusions: Variations in overall health care utilization and costs across VISNs may suggest inconsistencies in practice patterns, quality of care, access to VA facilities. GIS can summarize these multidimensional measurements across geographic regions.

Impact: Information about geographic variations in health care utilization and costs provides a basis for examining resource allocation, practice patterns, and access to care. A clear understanding of the distribution, associated costs, and healthcare utilization of patients with these medical conditions provides policymakers with information for prioritizing resource allocation.