Effect of Veterans Administration use on indicators of diabetes care in a national sample of veterans.
BACKGROUND
Diabetes poses a serious health burden, of which veterans have a disproportionate share. Few data exist regarding differences in self-care behaviors and provider-based quality of care indicators among a large sample of veterans. The objective of this study was to determine the effect of Veterans Affairs (VA) use on diabetes quality of care indicators among veterans.


METHODS
A cross-sectional analysis was done on data from 36,525 veterans in the 2003 Behavioral Risk Factor Surveillance Survey. VA use was defined as receiving some or all health care from a VA facility in the previous 12 months. Diabetes quality indicators such as two or more provider visits, two or more hemoglobin A1c tests, and flu and pneumonia shots were compared between VA users and non-VA users. The independent effect of VA use on each quality indicator was analyzed with multiple regression using STATA version 10 (Stata Press, College Station, TX) to account for the complex survey design and yield population estimates.


RESULTS
Among veterans with diabetes, 26.8% were VA users. The only significant difference between VA users and non-VA users was that VA users were significantly more likely to check their feet one or more times daily (75.7% vs. 68.5%, P = 0.015). In final adjusted models, VA users were at least twice as likely as non-VA users to have foot exams by a provider (odds ratio 2.59) and receive flu and pneumonia shots (odds ratio 2.30 and 2.05, respectively). VA users were also more likely to have two or more provider visits, dilated eye exams, and two or more hemoglobin A1c tests than non-VA users.


CONCLUSIONS
Key quality indicators for diabetes care were better among veterans getting some or all of their care from VA facilities, suggesting more effective care strategies. However, interventions should identify and perpetuate excellent self-care behaviors to more substantially impact adverse diabetes-related outcomes.
Lynch
Cheryl P
CP
Charleston VA Research Enhancement Award Program, Ralph H. Johnson Veteran Affairs Medical Center, Charleston, South Carolina 29456, USA. lynchcp@musc.edu
Strom
Joni L
JL
Egede
Leonard E
LE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000592:standards / Q000706:statistics & numerical data; D006304:Health Status; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012648:Self Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards* / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data
Ann Intern Med. 2004 Dec 21;141(12):938-45
15611491
Ann Intern Med. 2004 Aug 17;141(4):272-81
15313743
Diabetes Educ. 2005 Jan-Feb;31(1):53, 55-6, 61
15779247
N Engl J Med. 2003 May 29;348(22):2218-27
12773650
J Sci Med Sport. 2004 Apr;7(1 Suppl):52-9
15214602
Diabetes Care. 2006 Jun;29(6):1263-8
16732006
Diabetes Care. 2003 Mar;26(3):602-7
12610008
Diabetes Care. 2004 May;27 Suppl 2:B69-73
15113786
Diabetes Care. 2008 May;31(5):869-73
18285552
Diabetes Care. 2004 May;27 Suppl 2:B61-8
15113785
Diabetes Care. 2004 May;27 Suppl 2:B45-9
15113782
Diabetes Care. 2009 Jan;32 Suppl 1:S6-12
19118288
Diabetes Care. 2004 May;27 Suppl 2:B3-9
15113776
Diabetes Educ. 2004 Mar-Apr;30(2):274-80
15095517
J Gen Intern Med. 2007 Jan;22(1):115-20
17351850
J Womens Health (Larchmt). 2007 Oct;16(8):1188-99
17937572