title: Healthcare use by veterans treated for diabetes mellitus in the Veterans Affairs medical care system.
abstract: OBJECTIVE
  To estimate the burden of comorbid conditions and to describe patterns of inpatient and outpatient service use by veterans with diabetes mellitus.
  
  
  METHODS
  Retrospective cohort study of 33,481 veterans conducted by means of secondary analysis of Department of Veterans Affairs (VA) healthcare utilization databases.
  
  
  METHODS
  The cohort was constructed by enrolling all veterans treated in the VA medical care system who had their initial VA hospitalization for diabetes mellitus between 1992 and 1997. To estimate the typical annual pattern of service use for diabetes mellitus, 1997 utilization rates per person-year were analyzed based on cohort members surviving into 1997. Data on comorbid conditions were obtained from outpatient and inpatient contacts.
  
  
  RESULTS
  The 3 most prevalent coexisting conditions were hypertension (73.4%), ischemic heart disease (35.2%), and alcohol or drug abuse disorders (29.5%). In 1997, the typical cohort member followed for 12 months had 6 primary care visits, 16 other visits for tests or consultations, and 1.3 unscheduled visits for emergency or urgent care and spent approximately 8 days in the hospital. One-year survival was 94.0%.
  
  
  CONCLUSIONS
  In the VA medical care system, beneficiaries with diabetes mellitus have an extremely heavy burden of comorbidities, face a significant risk of dying in a given year (approximately 6% in this population), and are heavy users of hospital and outpatient services.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center, and Department of Medicine, Baylor College of Medicine, Houston, Tex 77030, USA. cashton@bcm.tmc.edu
authors.forename: Carol M
authors.initials: CM
authors.lastname: Ashton
authors.forename: Joshua
authors.initials: J
authors.lastname: Septimus
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Petersen
authors.forename: Julianne
authors.initials: J
authors.lastname: Souchek
authors.forename: Terri J
authors.initials: TJ
authors.lastname: Menke
authors.forename: Tracie C
authors.initials: TC
authors.lastname: Collins
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D017281:Cost of Illness; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D020379:Risk Adjustment; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D014728:Veterans / Q000706:statistics & numerical data*