title: Multiple system utilization and mortality for veterans with stroke.
abstract: OBJECTIVE
  Many Veteran Health Administration (VHA) enrollees receive health services outside the VHA system. However, limited information is available about poststroke utilization and mortality by veterans who used multiple sources of health care. This study assessed the likelihood of 12-month poststroke rehospitalization and mortality of veterans who used VHA only versus those who used multiple sources of care.
  
  
  METHODS
  Our retrospective observational study examined veterans living in Florida and diagnosed with acute stroke. We categorized users into 4 groups: VHA-only, VHA-Medicare, VHA-Medicaid, and VHA-Medicare-Medicaid based on their use of each health care program. Logistic regression models were fitted for 12-month poststroke general rehospitalization, recurrent stroke readmission, and mortality, adjusting for sociodemographic and clinical factors.
  
  
  RESULTS
  The sample consisted of 29% VHA-only users, 61% VHA-Medicare users, 3% VHA-Medicaid users, and 7% VHA-Medicare-Medicaid triple users. Compared with the VHA-only users, multiple system users were significantly more likely to be rehospitalized for any cause and for recurrent stroke 12-months postindex. Mortality outcomes depended on when the outcome was measured; at the index admission date, we found no significant difference in mortality across the user groups; at the index discharge date, the VHA-only users was less likely to die within the first 12 months than the users of the 2 dual groups (VHA-Medicare and VHA-Medicaid).
  
  
  CONCLUSIONS
  Multiple health care source use was common among VHA enrollees with acute stroke in Florida. Multiple system users were more likely to be rehospitalized and the mortality outcomes were dependent on when the outcome was measured.
authors.affiliation: Department of Veterans Affairs Rehabilitation Outcomes Research Center, Gainesville, FL 32608, USA. Huanguang.Jia@med.va.gov
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Yu
authors.initials: Y
authors.lastname: Zheng
authors.forename: Dean M
authors.initials: DM
authors.lastname: Reker
authors.forename: Diane C
authors.initials: DC
authors.lastname: Cowper
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Gail C
authors.initials: GC
authors.lastname: Young
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005431:Florida; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D012041:Regional Medical Programs; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality* / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans