The impact of VA priority score on use of fecal occult blood test in VA and Medicare systems.
Schult-T; Virnig-B; Kochevar-L; Nelson-D; Bershadsky-B
AcademyHealth 2005 Annual Research Meeting (ARM), Boston, Massachusetts, June 26-28, 2005. Washington DC: AcademyHealth, 2005 Jun; :23
Research Objective: To describe patterns of VA and non-VA use of the fecal occult blood test, FOBT, for veterans enrolled in both VA and Medicare. Study Design: This analysis utilized data from the VA Colorectal Cancer QUERI's Colorectal Cancer Screening and Follow-up Event surveillance system - CRC-SAFE. CRC-SAFE is designed to collect data needed to estimate: variation in screening and follow-up rates by patient characteristics; reliability and validity of combined VA and Medicare administrative databases for assessing and tracking recommended colorectal cancer screening and follow-up practices; and impact of Medicare service coverage on the screening and follow-up rates of VA users. When veterans enroll in VA, they are assigned into one of seven priority groups based on service-connected and other disability, income, and special considerations. Patterns of use were compared for the following two groups: Group 1 - VA enrollees who are catastrophically disabled, with low-income, or with service-connected disability 50 percent or more and Group 2 - enrollees in the other four priority groups including POWs and veterans with service-connection less than 50 percent. Enrollees in Group 1 are more likely to have no private insurance or only basic Medicare coverage. Population Studied: The population was comprised of 73,145 veterans with dual enrollment in VA and Medicare aged 65 years and older in 2001 and 2002 that had used services at one of four VA facilities, including Durham, Minneapolis, Portland or West L.A, and were not enrolled in a Medicare HMO during this time. Principal Findings: Overall, 55.2 percent of dual users were in Group 1 and 44.8 percent were in Group 2. Use of FOBTs did not vary considerably between priority groups. For Group 1, 32.2 percent had a FOBT in the 12 months preceding their most recent visit to a VA or non-VA provider. The majority, 87.3 percent obtained the FOBT in a VA facility, 10.4 percent in a non-VA facility, and 2.3 percent in both. For Group 2, 32.5 percent had a FOBT in the previous 12 months. However, a smaller percentage, 66.1 percent obtained the FOBT in a VA facility, while 26.1 percent obtained the FOBT in a non-VA facility, and 4.0 percent obtained FOBTs in both types of facilities. Conclusions: The overall FOBT utilization for Group 1 was very similar to that of Group 2. In addition, the findings regarding location of FOBT utilization by priority group are consistent with more general results from the 1999 Large Health Survey of VA Enrollees, which found that dual enrollees without supplemental Medicare coverage, including Medigap or other private insurance, relied more on the VA for most of their care, while VA enrollees with supplemental coverage used primarily non-VA providers.
Analytical-processes; Digestive-system; Gastrointestinal-system; Health-services; Intestinal-cells; Intestinal-tissue; Medical-examinations; Medical-facilities; Medical-screening; Statistical-analysis
Tamara Schult, M.P.H., Doctoral Trainee/Data Manager, Occupational Health Services Research and Policy/VA Colorectal Cancer QUERI, University of Minnesota/Mpls VA Medical Center, One Veterans Drive (152/2E), Minneapolis, MN 55417
AcademyHealth 2005 Annual Research Meeting (ARM), Boston, Massachusetts, June 26-28, 2005
University of Minnesota Twin Cities