title: Home health care and patterns of subsequent VA and medicare health care utilization for veterans.
abstract: OBJECTIVE
  The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HHC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched controls. We also consider crossover between the VA and Medicare.
  
  
  METHODS
  This is a retrospective study using propensity score and stratified analysis to control for selection bias on observable characteristics. We examined the full cohort of 2002 VA HHC users (n = 24,169) and a 2:1 sample of age- and race-based nonusers (n = 53,356). Utilization measures included VA and Medicare outpatient, inpatient, nursing home, and hospice use, as well as VA home-based primary care, respite care, and adult day health care.
  
  
  RESULTS
  VA HHC users had a higher absolute probability of outpatient use by around 3%, of inpatient use by 12%, and nursing home use by 6% than their propensity-score-matched controls.
  
  
  CONCLUSIONS
  Veterans who used HHC services had a higher rate of VA service use in the subsequent year than controls did, even after we adjusted for differences in observed health status, eligibility advantages, and supplemental insurance status. High utilization for VA home health users spilled over into high Medicare utilization.
authors.affiliation: Health Services Research and Development in Primary Care, Durham VA Medical Center, Durham, NC 27705, USA. courtney.vanhoutven@duke.edu
authors.forename: Courtney Harold
authors.initials: CH
authors.lastname: Van Houtven
authors.forename: Amy S
authors.initials: AS
authors.lastname: Jeffreys
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
mesh_terms: D000368:Aged; D006296:Health Services / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare; D012189:Retrospective Studies; D014481:United States; D014728:Veterans