1099 — The Veterans Health Administration Residential History File: A Resource for Research and Operations

Intrator O, Canandaigua VAMC; Makineni R, Canandaigua VAMC; Cai S, Canandaigua VAMC; Miller SC, Canandaigua VAMC;

Objectives:
The ability to link utilization chronologically is important for evaluation and planning of many VA programs. In particular, care of frail older adult Veterans is often times co-managed by Veterans' Health Administration (VHA) and community providers paid by Medicare or Medicaid. Linking data from these administrative data sources is complex, requires in-depth understanding of the data collection methods, and is extremely data processing intensive.

Methods:
A Residential History File (RHF) methodology was developed which creates a daily chronological history of health service utilization and spans consecutive days at with the same services into episodelets of care. The RHF receives inputs from VA, Medicare and Medicaid claims and enrollment records and Minimum Data Set assessments from Community Living Centers, State Veterans Homes and nursing homes in the community. By standardizing the data and laying it on a calendar it is possible to more easily deal with the multiplicity of data inputs and their vagaries in a consistent manner.

Results:
We performed a validation test of the place of death identified in the RHF as compared to location of death in the National Death Index. We found that the RHF was highly accurate with over 90% agreement in identifying location at time of death. Moreover, the RHF was more specific, for example was able to associate death with hospice in a nursing home setting as compared to in the community.

Implications:
The RHF makes it possible to examine trajectories of health care utilization paid by VA, Medicare, and Medicaid and begin to address the issues of co-managed care.

Impacts:
In order to provide quality care it is imperative that co-managed care be done effectively in order to reduce undue burden on Veterans and their caregivers, as well as contain costs across the various government programs. Beyond providing a well-integrated Big Data resource for evaluation and research purposes, the RHF can be created on a rapid cycle and fed into patients' charts to assist clinicians understand the myriad of care their patients are receiving and to be able to make sense of all the data that is in their charts.