title: Rural veterans and access to high-quality care for high-risk surgeries.
abstract: OBJECTIVE
  To determine whether older Veterans Health Administration (VA) health care enrollees obtain most high-risk surgeries in non-VA hospitals under Medicare, whether residence in less populous areas increases this reliance on non-VA care or the likelihood of obtaining it in hospitals with higher mortality rates, and whether directing VA enrollees to better hospitals would add a substantial travel burden.
  
  
  METHODS
  VA and Medicare hospital discharge data from 2000 and 2001 for VA enrollees 65 years or older who received any of 14 high-risk elective procedures, including heart, vascular, and cancer surgeries. STUDY DESIGN/DATA EXTRACTION: We compared urban, suburban, and rural patients on use of VA versus non-VA hospitals, use of non-VA hospitals of higher versus lower mortality rates, travel times to get to these hospitals, and the additional travel burden if they had gone to lower mortality hospitals.
  
  
  RESULTS
  Regardless of residence, VA enrollees obtained most high-risk surgeries in non-VA hospitals. Urban veterans were most likely to get heart or cancer surgeries in lower mortality hospitals, but rural veterans were most likely to get vascular surgeries in lower mortality hospitals. Average travel times to lower or higher mortality hospitals did not differ greatly.
  
  
  CONCLUSIONS
  Accessing better hospitals need not add a great travel burden for rural veterans.
authors.affiliation: VA Outcomes Group Research Enhancement Award Program, Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
authors.forename: Alan N
authors.initials: AN
authors.lastname: West
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
authors.forename: Amy E
authors.initials: AE
authors.lastname: Wallace
mesh_terms: D000368:Aged; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*