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Shen Y, Hendricks A. Geographic variations in VA acute lengths of stay. Bedford, MA: HCFE; 2004 Mar 23. 1-22 p. Report No.: HCFE Working Paper No. 2004-03.
Background: In 1997, the Veterans' Health Administration (VA) implemented the Veterans Equitable Resource Allocation budget system. Funding for the 22 Veterans Integrated Service Networks (VISNs) was based on a fixed amount per enrolled patient in each of two categories of care. With similar management structures and budget incentives, networks are expected to provide care efficiently. This study examined inpatient care to assess variations that might signal inefficiencies. Methods: Discharge rates and use of acute wards (beds) were compared across VISNs using VA FY 1998 inpatient data. To capture the complexity of VA inpatient care, acute inpatient episodes were based on bed section information. Overall length of stay (LOS) for acute care and LOS for the 60 most frequent medical and surgical groups of patients were compared, adjusting for severity measured by APR-DRGs and patient characteristics. Results: VA inpatients averaged 1.7 acute discharges in FY 1998. The number varied by a factor of 1.2 across networks. The national average acute LOS was 7.8 days, with a range from 6.2 days to 10.2 days (a factor of 1.6) across networks. Northeast VISNs had the longest acute LOS. Five western networks had the shortest. However, this geographic pattern was not uniform. Conclusions: Variations in practice patterns across VA networks persist when inpatient severity and other characteristics are taken into account. Further studies are needed to understand the factors underlying differences in practice patterns.