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Open Access Highly Accessed Research article

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers

Virginia Wang12*, Matthew L Maciejewski12, Uptal D Patel13, Karen M Stechuchak1, Denise M Hynes456 and Morris Weinberger17

Author Affiliations

1 Health Services Research and Development, Durham VA Medical Center, Durham, NC, 27705, USA

2 Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, 27705, USA

3 Division of Nephrology, Department of Medicine, Duke University, Durham, NC, 27705, USA

4 VA Information Resource Center, Hines VA Hospital, Riverside, IL, 60546, USA

5 Center for Management of Complex Chronic Care, Hines VA Hospital, Riverside, IL, 60546, USA

6 Department of Medicine, University of Illinois-Chicago College of Medicine, Chicago, IL, 60612, USA

7 Department of Health Policy and Management, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA

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BMC Health Services Research 2013, 13:26  doi:10.1186/1472-6963-13-26

Published: 18 January 2013

Abstract

Background

Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcomes are similar for veterans receiving dialysis from VA versus non-VA providers. We assessed the extent of chronic dialysis treatment utilization and differences in all-cause hospitalizations and mortality between veterans receiving dialysis from VA versus VA-outsourced providers.

Methods

We constructed a retrospective cohort of veterans in 2 VA regions who received chronic dialysis treatment financed by VA between January 2007 and December 2008. From VA administrative data, we identified veterans who received outpatient dialysis in (1) VA, (2) VA-outsourced settings, or (3) both (“dual”) settings. In adjusted analyses, we used two-part and logistic regression to examine associations between dialysis setting and all-cause hospitalization and mortality one-year from veterans’ baseline dialysis date.

Results

Of 1,388 veterans, 27% received dialysis exclusively in VA, 47% in VA-outsourced settings, and 25% in dual settings. Overall, half (48%) were hospitalized and 12% died. In adjusted analysis, veterans in VA-outsourced settings incurred fewer hospitalizations and shorter hospital stays than users of VA due to favorable selection. Dual-system dialysis patients had lower one-year mortality than veterans receiving VA dialysis.

Conclusions

VA expenditures for “buying” outsourced dialysis are high and increasing relative to “making” dialysis treatment within its own system. Outcomes comparisons inform future make-or-buy decisions and suggest the need for VA to consider veterans’ access to care, long-term VA savings, and optimal patient outcomes in its placement decisions for dialysis services.

Keywords:
Veterans; Dialysis; Hospitalization; Mortality