title: Impact of Multisystem Health Care on Readmission and Follow-up Among Veterans Hospitalized for Chronic Obstructive Pulmonary Disease.
abstract: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of readmission at Veterans Affairs (VA) hospitals. Previous studies demonstrate worse outcomes for veterans with multisystem health care, though the impact of non-VA care on COPD readmissions is unknown.
  
  
  
  To examine the association of use of non-VA outpatient care with 30-day readmission and 30-day follow-up among veterans admitted to the VA for COPD.
  
  
  
  This is a retrospective cohort study using VA administrative data and Medicare claims.
  
  
  
  In total, 20,472 Medicare-eligible veterans who were admitted to VA hospitals for COPD during October 1, 2008 and September 30, 2011.
  
  
  
  We identified the source of outpatient care during the year before the index hospitalization as VA-only, dual-care (VA and Medicare), and Medicare-only. Outcomes of interest included any-cause 30-day readmission, COPD-specific 30-day readmission and follow-up visit within 30 days of discharge. We used mixed-effects logistic regression, controlling for baseline severity of illness, to examine the association between non-VA care and postdischarge outcomes.
  
  
  
  There was no association between non-VA care and any-cause readmission. We did identify an increased COPD-specific readmission risk with both dual-care [odds ratio (OR)=1.20; 95% confidence interval (CI), 1.02-1.40] and Medicare-only (OR=1.41; 95% CI, 1.15-1.75). Medicare-only outpatient care was also associated with significantly lower rates of follow-up (OR=0.81; 95% CI, 0.72-0.91).
  
  
  
  Differences in disease-specific readmission risk may reflect differences in disease management between VA and non-VA providers. Further research is needed to understand how multisystem care affects coordination and other measures of quality for veterans with COPD.
authors.affiliation: *Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford †The Pulmonary Center, Boston University School of Medicine ‡Department of Veterans Affairs, VA Boston Healthcare System §Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA ∥Department of Veterans Affairs, Pain Research, Informatics, Multimorbidity and Education Center, VA Connecticut Healthcare System, West Haven ¶Department of Medicine, Yale University, New Haven, CT #Department of Veterans Affairs, Health Services Research and Development Center, VA Puget Sound Health Care System **Department of Health Services, University of Washington, Seattle, WA.
authors.forename: Seppo T
authors.initials: ST
authors.lastname: Rinne
authors.forename: Anashua R
authors.initials: AR
authors.lastname: Elwy
authors.forename: Lori A
authors.initials: LA
authors.lastname: Bastian
authors.forename: Edwin S
authors.initials: ES
authors.lastname: Wong
authors.forename: Renda S
authors.initials: RS
authors.lastname: Wiener
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care; D006760:Hospitalization; D006801:Humans; D007345:Insurance Claim Review; D008875:Middle Aged; D009096:Multi-Institutional Systems; D010359:Patient Readmission / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive; D012189:Retrospective Studies; D058014:Veterans Health