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Health Services Research & Development

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HSR&D In Progress

December 2021

In This Issue: HSR&D Advances Research in Providing Healthcare for Veterans in Rural Settings
» Table of Contents


Effect of Rurality and Social Risk Factors on Barriers to Care and Surgical Outcomes

Feature Article


Takeaway: This study combines diverse data sources to develop predictive models with the potential to provide clinicians and administrators with outcomes and economic analyses necessary to change institutional practices that benefit our most vulnerable Veterans, particularly those who live in rural settings with limited healthcare resources.


The MISSION Act provides improved Veteran access to care both within VA and community healthcare systems. An underlying assumption is that faster care with more choices results in better care. However, care fragmentation is associated with increased length of stay, readmissions, and mortality. Post-operative complications and readmissions are higher in minority and low socioeconomic status (SES) patients. Low SES is also associated with frailty, one of the best predictors of 30-day postoperative complications and hospital readmissions. Despite having a profound influence on health outcomes, social risk factors are absent from risk adjustment for VA quality measures, further exacerbating disparities in minority and low SES populations. This strategy may further constrain resources to care for vulnerable populations, as many Veterans are economically disadvantaged, and it may potentially add avoidable costs to care delivery . Another major issue is care fragmentation. Nevertheless, the impact of non-VA care and care fragmentation is absent in performance metrics.

The goal of this ongoing study (October 2021 – March 2025) is to identify important risk factors for post-operative complications, readmissions, and mortality. Investigators will assess the impact of social risk factors and care fragmentation on hospital performance metrics for readmissions and mortality. They also seek to determine the relationship between the Veteran’s place of residence (urban vs rural), care fragmentation, SES, and minority status – and acute and long-term VA surgical healthcare use.

Methodology

Investigators aim to improve upon current surgical practices by joining surgical outcomes data with VA/Centers for Medicare & Medicaid Services (CMS) claims data – and with VA fee-basis files – to identify encounters outside of the VA healthcare system. Investigators also will examine proxy social risk factors, as well as neighborhood disadvantage, such as rural settings with fewer healthcare resources.

Findings

Nothing to report at this time.

Anticipated Impact

Investigators in this study will combine diverse data sources to develop predictive models with the potential to provide clinicians and administrators with outcomes and economic analyses necessary to change institutional practices that benefit our most vulnerable Veterans, particularly those who live in rural settings with limited healthcare resources.

Principal Investigator

Paula Shireman, MD, MS, MBA, is an academic vascular surgeon and physician scientist in the School of Medicine at the University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System.

Publications: Nothing to report at this time.

View study abstract

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