Lower comorbidity scores and severity levels in Veterans Health Administration hospitals: a cross-sectional study

• Published in: BMC health services research Vol. 24; no. 1; p. 601
• Main Authors: Dizon, Matthew P, Chow, Adam, Ong, Michael K, Phibbs, Ciaran S, Vanneman, Megan E, Zhang, Yue, Yoon, Jean
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.05.2024; BioMed Central; BMC
• Subjects: Administrative data; Aged; Aged, 80 and over; Binomial distribution; Comorbidity; Cross-Sectional Studies; Diagnosis; Diagnosis related groups; Diagnosis-Related Groups - statistics & numerical data; Documentation; DRGs; Female; Generalized linear models; Government finance; Health aspects; Health care industry; Health care quality; Hospital costs; Hospitalization; Hospitals, Veterans; Hospitals, Veterans - statistics & numerical data; Humans; Male; Management; Marital status; Medicaid; Medical care; Medical centers; Medicare; Medicare - statistics & numerical data; Middle Aged; Military service; Observational study designs; Outcomes research; Probability; Quality management; Risk factors; Severity of Illness Index; Sociodemographics; Trends; United States - epidemiology; United States Department of Veterans Affairs - statistics & numerical data; Veterans; Veterans - statistics & numerical data; United States; Administrative data; Health care quality; Observational study designs; Outcomes research; Documentation
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-024-11063-3

Previous studies found that documentation of comorbidities differed when Veterans received care within versus outside Veterans Health Administration (VHA). Changes to medical center funding, increased attention to performance reporting, and expansion of Clinical Documentation Improvement programs, however, may have caused coding in VHA to change. Using repeated cross-sectional data, we compared Elixhauser-van Walraven scores and Medicare Severity Diagnosis Related Group (DRG) severity levels for Veterans' admissions across settings and payers over time, utilizing a linkage of VHA and all-payer discharge data for 2012-2017 in seven US states. To minimize selection bias, we analyzed records for Veterans admitted to both VHA and non-VHA hospitals in the same year. Using generalized linear models, we adjusted for patient and hospital characteristics. Following adjustment, VHA admissions consistently had the lowest predicted mean comorbidity scores (4.44 (95% CI 4.34-4.55)) and lowest probability of using the most severe DRG (22.1% (95% CI 21.4%-22.8%)). In contrast, Medicare-covered admissions had the highest predicted mean comorbidity score (5.71 (95% CI 5.56-5.85)) and highest probability of using the top DRG (35.3% (95% CI 34.2%-36.4%)). More effective strategies may be needed to improve VHA documentation, and current risk-adjusted comparisons should account for differences in coding intensity.