title: Rates of health services utilization and survival in patients with heart failure in the Department of Veterans Affairs medical care system.
abstract: The objective of this study was to describe patterns of hospital and clinic use and survival for a large nationwide cohort of patients with heart failure. A retrospective cohort study of patients treated in the Veterans Affairs medical care system was conducted using linked administrative databases as data sources. In 1996, the average heart failure cohort member had 1-2 hospitalizations, 14 inpatient days, 6-7 visits with the primary physician, 15 other visits for consultations or tests, and 1-2 urgent care visits per 12 months. The overall risk-adjusted 5-year survival rate was 36%. Hospital use rates in the cohort fell dramatically between 1992 and 1996. One-year survival rates increased slightly over the period. Patients with heart failure are heavy users of services and have a very poor prognosis. Utilization and outcome data indicate the need for major efforts to assure quality of care and to devise innovative ways of delivering comprehensive services.
authors.affiliation: Center for Quality of Care and Utilization Studies, VA Medical Center, Houston, TX, USA. cashton@bcm.tmc.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Ashton
authors.forename: N J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: J
authors.initials: J
authors.lastname: Souchek
authors.forename: T J
authors.initials: TJ
authors.lastname: Menke
authors.forename: K
authors.initials: K
authors.lastname: Pietz
authors.forename: H J
authors.initials: HJ
authors.lastname: Yu
authors.forename: N P
authors.initials: NP
authors.lastname: Wray
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*