Data acquisition process for VA and non-VA emergency department and hospital utilization by veterans with spinal cord injury and disorders in California using VA and state data

Abstract

Context: To identify VA and non-VA Emergency Department (ED) and hospital utilization by veterans with spinal cord injury and disorders (SCI/D) in California.

Design: Retrospective cohort study.

Setting: VA and Office of Statewide Health Planning and Development (OSHPD) in California.

Participants: Total 300 veterans admitted to the study VA SCI/D Center for initial rehabilitations from 01/01/1999 through 08/17/2014.

Interventions: N/A.

Outcome Measures: Individual-level ED visits and hospitalizations during the first-year post-rehabilitation.

Results: Among 145 veterans for whom ED visit data available, 168 ED visits were identified: 94 (55.2%) at non-VA EDs and 74 (44.8%) at the VA ED, with a mean of 1.16 (±2.21) ED visit/person. Seventy-seven (53.1%) veterans did not visit any ED. Of 68 (46.9%) veterans with ≥ one ED visit, 20 (29.4%) visited the VA ED only, 34 (50.0%) visited non-VA EDs only, and 14 (20.6%) visited both VA and non-VA EDs. Among 212 Veterans for whom hospitalization data were available, 247 hospitalizations were identified: 82 (33.2%) non-VA hospitalizations and 165 (66.8%) VA hospitalization with a mean of 1.17 (±1.62) hospitalizations/person. One hundred-seven (50.5%) veterans had no hospitalizations. Of 105 veterans with ≥ one hospitalization, 58 (55.2%) were hospitalized at the study VA hospital, 15 (14.3%) at a non-VA hospital, and 32 (30.5%) at both VA and non-VA hospitals.

Conclusion: Non-VA ED and hospital usage among veterans with SCI/D occurred frequently. The acquisition of non-VA healthcare data managed by state agencies is vital to accurately and comprehensively evaluate needs and utilization rates among veteran populations.

Keywords:

• Veterans
• Spinal cord injuries
• Health care utilization
• Hospitalization
• Emergency department visit
• Veterans’ health

Acknowledgements

We thank VA SCI/D registry specialist Alicia Shimabuku and data analyst Chi Pham and Hui Qin for assistance with the data extraction, clean up, and assistance in preparing data files.

Disclaimer statements

Contributors None.

Funding The fee for linkage of OSHPD data was funded by the Bay Area and Western Chapter of the Paralyzed Veterans of America. Dr Heejung Bang was partly supported by the National Institutes of Health through [grant number UL1 TR001860].

Conflicts of interest Authors have no conflict of interests to declare.

Compliance with ethical standards

Ethical Approval: All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Three institutional review boards – California State Committee for the Protection of Human Subjects, University of California at Davis, Stanford University/VA approved this study. Views expressed here are those of the authors and not necessarily those of the Department of Veterans Affairs or other affiliated organizations.

The interpretation and reporting of the data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.