disease burden, utilization and costs of care among women using veterans health administration herc...
TRANSCRIPT
Disease Burden, Utilization and Costs of Care Among Women
Using Veterans Health Administration
HERC Cyber Seminar
May 25, 2005
Presented by Ciaran Phibbs
3
Background• VA provides comprehensive
health care services: Psychiatric and Substance abuse
• Only recently have healthcare cost data become available for the VA Health Care System.
4
Background
• Services for women veterans becoming a higher priority as their numbers increase
• Very limited information on women veterans and their use of VA services
5
Objectives1) To build off of our previous
work looking at chronic conditions in all veterans,looking for differences by gender.
2) Work on the methods for indentifying female patients in VA
6
BackgroundPrevious work, Yu, W, Ravelo A, Wagner TH,
Phibbs CS, Bhandari A, Chen S, Barnett PG. Prevalence and Costs of Chronic Conditions in the VA Health Care System. Medical Care Research and Review, 2003;60:146S-167S.
7
Methods: Data and Sample
• Entire population of VA Health Care System users in FY 2002, profiled for common chronic diseases– 4,444,577 persons– 4,433,121 after deletions for missing
data
• Supplemented with conditions important to women.
8
Methods: Identification of Women VA Users
• 99.96 % of patients had consistent gender recorded across all health care encounters.
• 1,757 cases of discrepant gender.• For 1,151 >=50% of records listed
patient as female.• Excluded other 606 patients
9
Methods: Identification of Chronic Conditions
• Patients with 29 common chronic diseases identified by ICD-9 codes in 2 databases:
1. Inpatient: Main File of the Patient Treatment File database (PTF)
2. Outpatient: Event File of the National Patient Care Database (NPCD)
10
Methods: Classification of Chronic Conditions
• ICD-9 classification methods of health conditions based on review of:– Kaiser Permanente study (Ray et al 2000)– Previous VA studies– Clinical Classifications Software (CCS)
developed by the Agency for Healthcare Research and Quality (AHRQ).
• Any significant differences in disease classification were reviewed by physicians.
11
Methods: Addition of Conditions Important to Women
• Gender-specific conditions from CCS• Reviewed list of conditions from
VA’s National Women’s Health Project.
• Reviewed by a panel of physicians• Based on numbers of similarity,
collapsed some conditions, especially CCS for tractability.
12
Methods: Female-Specific Conditions
• Menopausal disorders• Inflammatory female pelvic disorders• Menstrual disorders• Other female genital disorders• Pregnancy• Infertility• Contraceptive management• Benign female pelvic neoplasms• Nonmalignant breast conditions• Female pelvic malignancies• Breast cancer
13
Methods: Male-Specific Conditions
• Two conditions from the original list were identified as male-specific conditions
–Prostatic hypertrophy
–Prostate cancer
14
Methods: Determination of Medical Care Cost (1)
• Annual costs include:– Inpatient care: Med/Surg and all
other costs
–Outpatient care
–Outpatient prescription drugs
–Does not include non-VA providers
15
Methods: Determination of Medical Care Cost (2)
• All data from HERC person-level cost files– Inpatient and Outpatient care costs
determined using HERC Average Cost Database–Outpatient prescription drug costs
reported by the VA Decision Support System (DSS) National Data Extract
16
Methods: Determination of Veteran’s Status
• All VA PTF and NPCD records indicate veteran status.
–Check for agreement across records; found very high agreement
–Created categorical variable to identify veteran’s vs. non-veteran’s
17
VA Users, By Gender and Veteran’s Status
Male Female
Veteran 3,940,148 178,463
Non-Veteran 129,470 185,040
18
Eligibility of Non-Veteran Female Users of VA Care, N=185,040
• 106,412 employees
• 25,283 VA sharing agreements
• 19,764 collaterals (eligible family members)
• 15,154 CHAMPVA
• 10,513 TriCare
19
Age Distributions of Female and Male Veterans Who Used VA in FY 2002
Women Men
Age (%) N=178,463 N=3,940,148
<45 42.5 9.4
45-54 25.8 18.0
55-64 10.0 20.1
65-74 7.1 26.3
75+ 14.6 26.2
20
Race/Ethnicity Distribution of Female and Male Veterans Who Used VA in FY 2002
Women Men
Race/Ethnicity (%)
N=178,463 N=3,940,148
White 39.6 42.9
Black 13.4 9.0
Hispanic 1.9 3.4
Other 0.6 0.5
Unknown 44.6 44.2
21
Marital Status of Female and Male Veterans Who Used VA in FY 2002
Women Men
Marital Status (%)
N=178,463 N=3,940,148
Married 34.1 60.8
Divorced 27.6 18.3
Widowed 9.6 6.8
22
VA Eligibility of Female and Male Veterans Who Used VA in FY 2002
Women Men
VA Eligibility (%) N=178,463 N=3,940,148
Cat A, service connected
42.2 30.9
Cat A, non-service connected
36.2 40.0
Category C 16.3 26.3
23
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Cardio- Women Men Age-Adj
vascular N=178,463 N=3,940,148 OR
Hypertension 28.6 48.9 0.65
Ischemic 5.5 20.4 0.38
CHF 1.6 4.5 0.59
Peri Vas Dis 1.3 4.4 0.49
24
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Women Men Age-Adj
N=178,463 N=3,940,148 OR
COPD 4.4 10.0 0.65
Asthma 6.2 2.5 2.35
Acid disorders
3.1 3.7 0.90
Hepatitis C 1.3 2.1 0.32
25
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Women Men Age-Adj
N=178,463 N=3,940,148 OR
Low back 15.8 11.6 1.10
Arthritis 16.6 17.8 1.08
Injury 12.6 8.1 1.27
Osteoporosis 5.5 0.8 13.64
26
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Women Men Age-Adj
N=178,463 N=3,940,148 OR
Stroke 1.0 2.2 0.68
MS 0.9 0.3 2.51
Headache 17.8 2.6 5.59
Dementia 0.7 1.2 1.15
27
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Women Men Age-Adj
N=178,463 N=3,940,148 OR
Depression 22.8 11.5 1.69
PTSD 6.7 5.1 0.88
Schizophrenia 3.0 2.4 0.76
Bipolar 4.4 1.7 1.62
28
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Women Men Age-Adj
N=178,463 N=3,940,148 OR
Paranoid 1.3 1.2 0.90
Personality 2.4 0.7 1.93
Substance 11.7 13.4 0.54
Other psych 31.7 20.8 1.33
29
Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002
Summary Women Men Age-Adj
N=178,463 N=3,940,148 OR
Any medical 65.6 77.9 0.81
Male 14.5
Female 31.6
Mental Health
38.0 29.9 1.01
30
Summarization of Utilization and Costs
• Aggregated the chronic/clinical conditions into four groups
–No medical or mental health conditions
–Medical conditions only
–Mental health conditions only
– Both medical and mental health conditions
31
Distributions of Women and Men Veterans By Health Conditions
None Medical Mental Health
Both
Women 43,560 67,010 17,748 50,145
Men 640,627 2,119,981 228,211 951,329
Age
Women 43.8 56.0 42.5 50.4
Men 59.5 67.2 52.7 60.9
32
VA Utilization By Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Num OP
Women 5.1 13.7 15.5 31.9
Men 4.2 12.7 16.6 27.4
Num IP
Women 1.21 0.94 2.53 3.50
Men 2.58 1.37 4.67 4.62
33
Inpatient VA Utilization By Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Med/Surg
Women 0.11 0.43 0.11 0.69
Men 0.28 0.68 0.24 1.09
MH/SA
Women 0.05 0.00 1.26 0.99
Men 0.11 0.01 1.74 0.86
34
Total Annual VA Costs for Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Women 1,422 3,159 3,640 7,279
(8,534) (8,774) (10,450) (13,769)
Men 2,128 3,756 4,391 7,557
(14,001) (11,715) (13,206) (15,647)
35
Total Inpatient VA Costs for Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Women 649 1,028 1,451 2,570
Men 1,456 1,622 2,299 3,4369
36
Total Outpatient VA Costs for Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Women 614 1,416 1,525 3,242
Men 503 1,337 1,523 2,808
37
Total VA Pharmacy Costs for Women and Men Veterans, By Health Conditions
None Medical Mental Health
Both
Women 158 715 663 1,468
Men 170 797 568 1,313