title: Estimating healthcare mobility in the Veterans Affairs Healthcare System.
abstract: Healthcare mobility, defined as healthcare utilization in more than one distinct healthcare system, may have detrimental effects on outcomes of care. We characterized healthcare mobility and associated characteristics among a national sample of Veterans.
  
  
  
  Using the Veterans Health Administration Electronic Health Record, we conducted a retrospective cohort study to quantify healthcare mobility within a four year period. We examined the association between sociodemographic and clinical characteristics and healthcare mobility, and characterized possible temporal and geographic patterns of healthcare mobility.
  
  
  
  Approximately nine percent of the sample were healthcare mobile. Younger Veterans, divorced or separated Veterans, and those with hepatitis C virus and psychiatric disorders were more likely to be healthcare mobile. We demonstrated two possible patterns of healthcare mobility, related to specialty care and lifestyle, in which Veterans repeatedly utilized two different healthcare systems.
  
  
  
  Healthcare mobility is associated with young age, marital status changes, and also diseases requiring intensive management. This type of mobility may affect disease prevention and management and has implications for healthcare systems that seek to improve population health.
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA. karen.wang@yale.edu.|Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA. karen.wang@yale.edu.|Yale School of Medicine, Equity Research and Innovation Center, New Haven, CT, USA. karen.wang@yale.edu.
authors: Karen H
authors: KH
authors: Wang
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors: Joseph L
authors: JL
authors: Goulet
authors: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors: Constance M
authors: CM
authors: Carroll
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
authors: Melissa
authors: M
authors: Skanderson
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
authors: Samah
authors: S
authors: Fodeh
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Yale School of Medicine, Center for Medical Informatics, New Haven, CT, USA.
authors: Joseph
authors: J
authors: Erdos
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Yale School of Nursing, West Haven, CT, USA.
authors: Julie A
authors: JA
authors: Womack
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors: Erica A
authors: EA
authors: Abel
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
authors: Harini
authors: H
authors: Bathulapalli
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
authors: Amy C
authors: AC
authors: Justice
authors: Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.|Yale School of Medicine, Equity Research and Innovation Center, New Haven, CT, USA.
authors: Marcella
authors: M
authors: Nunez-Smith
authors: Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.|Yale School of Medicine, Center for Medical Informatics, New Haven, CT, USA.
authors: Cynthia A
authors: CA
authors: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D004641:Emigration and Immigration; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Geographic mobility; Healthcare utilization; Migration; Veterans