Geographic variations in utilization rates in veterans affairs hospitals and clinics

New England Journal of Medicine

Volumn 340, Issue 1, 1999, Pages 32-39

  Ashton, Carol M ^b   Petersen, Nancy J ^c   Souchek, Julianne ^c   Menke, Terri J ^c   Hong Jen, Yu ^c   Pietz, Kenneth ^c   Eigenbrodt, Marsha L ^c   Barbour, Galen ^a   Kizer, Kenneth W ^a   Wray, Nelda P ^c  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

^b MICHAEL E DEBAKEY VETERANS AFFAIRS MEDICAL CENTER   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE DELIVERY; HEALTH CARE SYSTEM; HEALTH CARE UTILIZATION; HOSPITAL DISCHARGE; HOSPITALIZATION; HUMAN; MEDICAL FEE; OUTPATIENT; PHYSICIAN ATTITUDE; PRIORITY JOURNAL;

CHRONIC DISEASE; COHORT STUDIES; HOSPITAL BED CAPACITY; HOSPITALS, VETERANS; HUMANS; LENGTH OF STAY; MALE; MULTIVARIATE ANALYSIS; OUTPATIENT CLINICS, HOSPITAL; PATIENT DISCHARGE; PHYSICIAN'S PRACTICE PATTERNS; RISK ADJUSTMENT; STATISTICS, NONPARAMETRIC; UNITED STATES; UTILIZATION REVIEW;

EID: 0033531089     PISSN: 00284793     EISSN: None     Source Type: Journal    
DOI: 10.1056/NEJM199901073400106     Document Type: Article

References (37)

1. Pokras R, Kozak LJ, McCarthy E, Graves EJ. Trends in hospital utilization. United States, 1965-86. Vital and health statistics. Series 13. No. 101. Washington, D.C.: Government Printing Office. 1989. (DHHS publication no. (PHS) 89-1762.)
2. Gornick M. Medicare patients: geographic differences in hospital discharge rates and multiple stays. Soc Secur Bull 1977;40:22-41.
3. Welch WP, Miller ME, Welch HG, Fisher ES, Wennberg JE. Geographic variation in expenditures for physicians' services in the United States. N Engl J Med 1993;328:621-7.
4. Graves EJ. National Hospital Discharge Survey: annual summary, 1993. Vital and health statistics. Series 13. No. 121. Washington, D.C.: Government Printing Office, 1995. (DHHS publication no. (PHS) 95-1782.)
5. Wennberg JE, Barnes BA, Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med 1982;16:811-24.
6. Wennberg JE, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med 1989;321:1168-73.
7. Siu AL, Sonnenberg FA, Manning WG, et al. Inappropriate use of hospitals in a randomized trial of health insurance plans. N Engl J Med 1986; 315:1259-66.
8. Restuccia J, Shwartz M, Ash A, Payne S. High hospital admission rates and inappropriate care. Health Aff (Millwood) 1996;15(4):156-63.
9. Knickman JR, Foltz AM. A statistical analysis of reasons for East-West differences in hospital use. Inquiry 1985;22:45-58.
10. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med 1989;321:86-92.
11. Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA 1992;268: 2388-94.
12. Bindman AB, Grumbach K, Osmond D, et al. Preventable hospitalization and access to health care. JAMA 1995;274:305-11.
13. Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Aff (Millwood) 1996;15(3):239-49.
14. Friss L, Friedman B, Demakis J. Geographic differences in the use of Veterans Administration hospitals. Soc Sci Med 1989;28:347-54.
15. Veterans' Health Care Eligibility Reform Act of 1996, PUB. L. no. 104-262, 110 Stat. 3177-3211 (1996).
16. Ashton CM, Petersen NJ, Wray NP, Yu HJ. The Veterans Affairs medical care system: hospital and clinic utilization statistics for 1994. Med Care 1998;36:793-803.
17. National Center for Veteran Analysis and Statistics. National survey of veterans. Washington, D.C.: Government Printing Office, April 1995. (Publication no. NSV9503.)
18. Wilson NJ, Kizer KW. The VA health care system: an unrecognized national safety net. Health Aff (Millwood) 1997;16(4):200-4.
19. Kizer KW, Garthwaite TL. Vision for change: an integrated service network. In: Kolodner RM, ed. Computerizing large integrated health networks: the VA success. New York: Springer-Verlag, 1997:3-13.
20. Kizer KW, Pane GA. The "new VA": delivering health care value through integrated service networks. Ann Emerg Med 1997;30:804-7.
21. Kizer KW, Fonseca ML, Long LM. The veterans healthcare system: preparing for the twenty-first century. Hosp Health Serv Admin 1997;42: 283-98.
22. Kizer KW. The changing face of the Veterans Affairs health care system. Minn Med 1997;80:24-8.
23. Idem. A vision for change: a plan to restructure the Veterans Health Administration. Washington, D.C.: Department of Veterans Affairs, March 1995.
24. Idem. Prescription for change: the guiding principles and strategic objectives underlying the transformation of the veterans health care system. Washington, D.C.: Department of Veterans Affairs, March 1996.
25. Idem. Veterans Equitable Resource Allocation (VERA): equity of funding and access to care across networks. Washington, D.C.: Department of Veterans Affairs, March 1997.
26. Iglehart JK. Reform of the Veterans Affairs health care system. N Engl J Med 1996;335:1407-11.
27. Page WF, Mahan CM, Kang HK. Vital status ascertainment through the files of the Department of Veterans Affairs and the Social Security Administration. Ann Epidemiol 1996;6:102-9.
28. International classification of diseases. 9th rev. Clinical modification: ICD-9-CM. New York: McGraw-Hill, 1996.
29. Ashton CM, Petersen NJ, Souchek J, et al. Rates of health services utilization and survival in patients with heart failure in the Department of Veterans Affairs medical care system. Am J Med Qual (in press).
30. Wray NP, Peterson NJ, Souchek J, Ashton CM, Hollingsworth JC. Application of an analytic model to early readmission rates within the Department of Veterans Affairs. Med Care 1997;35:768-81.
31. Rabeneck LR, Wray NP, Petersen NJ. Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes. J Gen Intern Med 1996;11:287-93.
32. Snedecor GW, Cochran WG. Statistical methods. 7th ed. Ames: Iowa State University Press, 1980:365-88.
33. Center for Evaluative Clinical Sciences. The Dartmouth atlas of health care. Chicago: American Hospital Publishing, 1996.
34. McPherson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med 1982;307: 1310-4.
35. Schappert SM. National Ambulatory Medical Care Survey, 1991 summary. Vital and health statistics. Series 13. No. 116. Washington, D.C.: Government Printing Office, 1994. (DHHS publication no. (PHS) 94-1777.)
36. Miller MG, Miller LS, Fireman B, Black SB. Variation in practice for discretionary admissions: impact on estimates of quality of hospital care. JAMA 1994;271:1493-8.
37. Fleming C, Fisher ES, Chang CH, Bubolz TA, Malenka DJ. Studying outcomes and hospital utilization in the elderly: the advantages of a merged data base for Medicare and Veterans Affairs hospitals. Med Care 1992;30:377-91.