Characteristics of Veterans With Non-VA Encounters Enrolled in a Trial of Standards-Based, Interoperable Event Notification and Care Coordination

Rebecca Kartje; Brian E. Dixon; Ashley L. Schwartzkopf; Vivian Guerrero; Kimberly M. Judon; Joanne C. Yi; Kenneth Boockvar

doi:10.3122/jabfm.2021.02.200251

Article Figures & Data

Tables

View popup

Table 1.

Baseline Characteristics of Veterans Enrolled Between 2016 and 2019 Stratified by Non-VA Alert Status

Variable	Alert (n = 197)	No Alert (n = 368)	Overall (n = 565)
Variable	No. (%) or Mean ± SD	No. (%) or Mean ± SD	No. (%) or Mean ± SD
Male sex	194 (98.5)	361 (98.1)	555 (98.3)
Age, years^*	77.1 ± 8.0	75.2 ± 7.5	75.8 ± 7.7
Race/ethnicity
White	134 (68.0)	210 (57.1)	344 (60.9)
Black	36 (18.3)	79 (21.5)	115 (20.4)
Hispanic	18 (9.1)	52 (14.1)	70 (12.4)
Asian	1 (0.5)	1 (0.3)	2 (0.4)
Multiracial	3 (1.5)	9 (2.5)	12 (2.1)
Other	5 (2.5)	17 (4.6)	22 (3.9)
Total annual individual income, $
0 to 10,000	10 (5.1)	19 (5.2)	29 (5.1)
10,001 to 25,000	62 (31.5)	119 (32.3)	181 (32.0)
25,001 to 50,000	54 (27.4)	116 (31.5)	170 (30.1)
50,001 to 100,000	38 (19.3)	78 (21.2)	116 (20.5)
100,001 to 250,000	13 (6.6)	8 (2.2)	21 (3.7)
> 250,000	2 (1.0)	0	2 (0.4)
Unknown/refused	18 (9.1)	28 (7.6)	46 (8.1)
Insurance type
Medicare	174 (88.3)	321 (87.2)	495 (87.6)
Medicaid	19 (9.6)	41 (11.1)	60 (10.6)
Private^*	116 (58.9)	179 (48.6)	295 (52.2)
Perceived health status
Excellent	14 (7.1)	32 (8.7)	46 (8.2)
Very good	37 (18.9)	88 (23.9)	125 (22.2)
Good	67 (34.2)	145 (39.4)	212 (37.6)
Fair	65 (33.2)	84 (22.8)	149 (26.4)
Poor	13 (6.6)	19 (5.2)	32 (5.7)
Any service connectedness	103 (52.3)	184 (50.0)	287 (50.8)
Chronic conditions
Charlson Comorbidity Index	1.4 ± 1.6	1.4 ± 1.9	1.4 ± 1.8
Chronic pulmonary disease	35 (17.8)	66 (17.9)	101 (17.9)
Congestive heart failure	20 (10.2)	35 (9.5)	55 (9.7)
Diabetes	86 (43.7)	160 (43.5)	246 (43.5)
Enrollment site
Bronx, NY	90 (45.7)	190 (51.6)	280 (49.6)
Indianapolis, IN	107 (54.3)	178 (48.4)	285 (50.4)
Travel time to VA, minutes^*	43.0 ± 28.6	37.6 ± 24.6	39.5 ± 26.2
RUCA^{^†}^*
Metropolitan	152 (77.2)	323 (87.8)	475 (84.1)
Micropolitan	25 (12.7)	29 (7.9)	54 (9.6)
Small town	6 (3.1)	6 (1.6)	12 (2.8)
Rural	9 (4.6)	7 (1.9)	16 (2.8)
Unknown	5 (2.5)	3 (0.8)	8 (1.4)
VA use in year before enrollment
Total # VA ED visits	0.7 ± 1.7	0.7 ± 1.4	0.7 ± 1.5
VA hospitalization	22 (11.2)	54 (14.7)	76 (13.5)
Receives majority of care^*
VA	146 (74.1)	313 (85.1)	459 (81.2)
Non-VA	46 (23.4)	48 (13.0)	94 (16.6)
Unknown/refused	5 (2.5)	7 (1.9)	12 (2.1)
Has a regular non-VA provider^*	119 (60.4)	181 (49.2)	300 (53.1)
(Yes, No)

ED, emergency department; VA, Veterans Affairs; SD, standard deviation.
↵* Bivariate analysis for Alert and No Alert comparisons was statistically significant at P < .05.
↵† Rural-urban commuting area codes:
Metropolitan, population > 50,000.
Micropolitan, population 10,000-49,999.
Small town, population 2500-9999.
Rural, population < 2500.

View popup

Table 2.

Characteristics of Hospitalizations and Emergency Department Visits Among Veterans Who Experienced a Non-VA Alert between 2016 and 2019 Stratified by Enrollment Site^*

Variable	Overall	Bronx	Indianapolis
Variable	No. (%) or Mean ± SD	No. (%) or Mean ± SD	No. (%) or Mean ± SD
Alert type
Hospital admission	92 (46.7)	51 (56.7)	41 (38.3)
Emergency department	105 (53.3)	39 (43.3)	66 (61.7)
Hospitalization length of stay, days	5.3 ± 5.5	6.7 ± 6.4	3.4 ± 3.1
Diagnosis group
Cardiovascular—other than chest pain	24 (13.9)	13 (16.3)	11 (11.8)
Trauma	21 (12.1)	10 (12.5)	11 (11.8)
Gastrointestinal	18 (10.4)	11 (13.8)	7 (7.5)
Musculoskeletal pain	15 (8.7)	3 (3.8)	12 (12.9)
Infection	14 (8.1)	7 (8.8)	7 (7.5)
Neurologic	11 (6.4)	5 (6.3)	6 (6.5)
Respiratory—other than pneumonia	11 (6.4)	6 (7.5)	5 (5.4)
Genitourinary—other than hematuriaor infection	6 (3.5)	3 (3.8)	3 (3.2)
Chest pain	5 (2.9)	2 (2.5)	3 (3.2)
Pneumonia	5 (2.9)	3 (3.8)	2 (2.2)
Hematuria	4 (2.3)	1 (1.3)	3 (3.2)
Inflammation	1 (0.6)	—	1 (1.1)
Musculoskeletal—other than painor trauma	1 (0.6)	—	1 (1.1)
Unknown	25 (14.5)	8 (10.0)	17 (18.3)
Other	12 (6.9)	8 (10.0)	4 (4.3)

SD, standard deviation; VA, Veterans Affairs.
↵* Alert type n = 197; Hospitalization length of stay n = 87, this variable was missing 5 values; Diagnosis group n = 173, this variable was missing 24 values.

View popup

Table 3.

Multivariable Logistic Regression Results for Odds of a Non-VA Alert, Spring 2016–Winter 2019 (n = 563)

Variable	OR (95% CI)^*
Male sex (ref = female)	1.15 (0.55, 2.43)
Age, years	1.05 (1.04, 1.05)
Race/ethnicity (ref = White)
Black	0.84 (0.55, 1.27)
Other	0.66 (0.42, 1.03)
Total annual individual income, $ (ref = ≤ 100,000)
> 100,000	4.01 (2.68, 5.98)
Unknown/refused	1.22 (0.88, 1.68)
Insurance type
Medicare (ref = no Medicare)	0.97 (0.57, 1.64)
Medicaid (ref = no Medicaid)	1.19 (1.17, 1.21)
Private (ref = no private)	1.39 (1.19, 1.62)
Perceived health status (ref = excellent)
Very good	0.96 (0.51, 1.80)
Good	1.10 (0.71, 1.70)
Fair	2.21 (1.24, 3.94)
Poor	2.01 (0.91, 4.46)
Any service connectedness (ref = no)	0.97 (0.75, 1.26)
Chronic conditions
Charlson Comorbidity Index	0.96 (0.89, 1.03)
Chronic pulmonary disease (ref = no)	1.06 (0.55, 2.05)
Congestive heart failure (ref = no)	1.44 (1.06, 1.95)
Diabetes (ref = no)	1.02 (0.93, 1.12)
Follow-up time, days	1.00 (1.00, 1.00)
Enrollment site (ref = Bronx, NY)
Indianapolis, IN	1.24 (0.80, 1.92)
Travel time to VA, minutes	1.00 (1.00, 1.01)
RUCA (ref = metropolitan)^{^†}
Micropolitan	1.93 (1.89, 1.97)
Small town	1.60 (1.35, 1.89)
Rural	2.67 (2.06, 3.47)
Unknown	4.63 (4.48, 4.80)
VA use in year before enrollment
Total # VA ED visits	1.13 (1.12, 1.13)
VA hospitalization (ref = no)	0.63 (0.57, 0.69)
Has a regular non-VA provider (ref = no)	1.21 (0.82, 1.78)
Receives majority of care (ref = VA)
Non-VA	1.83 (1.06, 3.15)
Unknown/refused	0.84 (0.83, 0.85)

ED, emergency department; VA, Veterans Affairs; CI, confidence interval; OR, odds ratio.
↵* Adjusted for other variables in the column.
↵† Rural-urban commuting area codes:
Metropolitan, population > 50,000.
Micropolitan, population 10,000–49,999.
Small town, population 2500–9999.
Rural, population < 2500.