Disease Burden, Utilization and Costs of Care Among Women Using Veterans Health Administration HERC Cyber Seminar May 25, 2005 Presented by Ciaran Phibbs

Disease Burden, Utilization and Costs of Care Among Women

Using Veterans Health Administration

HERC Cyber Seminar

May 25, 2005

Presented by Ciaran Phibbs

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Co-authors

Susan Frayne

Wei Yu

Lakshmi Ananth

Samina Iqbal

Ann Thrailkill

Elizabeth Yano

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Background• VA provides comprehensive

health care services: Psychiatric and Substance abuse

• Only recently have healthcare cost data become available for the VA Health Care System.

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Background

• Services for women veterans becoming a higher priority as their numbers increase

• Very limited information on women veterans and their use of VA services

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Objectives1) To build off of our previous

work looking at chronic conditions in all veterans,looking for differences by gender.

2) Work on the methods for indentifying female patients in VA

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BackgroundPrevious work, Yu, W, Ravelo A, Wagner TH,

Phibbs CS, Bhandari A, Chen S, Barnett PG. Prevalence and Costs of Chronic Conditions in the VA Health Care System. Medical Care Research and Review, 2003;60:146S-167S.

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Methods: Data and Sample

• Entire population of VA Health Care System users in FY 2002, profiled for common chronic diseases– 4,444,577 persons– 4,433,121 after deletions for missing

data

• Supplemented with conditions important to women.

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Methods: Identification of Women VA Users

• 99.96 % of patients had consistent gender recorded across all health care encounters.

• 1,757 cases of discrepant gender.• For 1,151 >=50% of records listed

patient as female.• Excluded other 606 patients

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Methods: Identification of Chronic Conditions

• Patients with 29 common chronic diseases identified by ICD-9 codes in 2 databases:

1. Inpatient: Main File of the Patient Treatment File database (PTF)

2. Outpatient: Event File of the National Patient Care Database (NPCD)

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Methods: Classification of Chronic Conditions

• ICD-9 classification methods of health conditions based on review of:– Kaiser Permanente study (Ray et al 2000)– Previous VA studies– Clinical Classifications Software (CCS)

developed by the Agency for Healthcare Research and Quality (AHRQ).

• Any significant differences in disease classification were reviewed by physicians.

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Methods: Addition of Conditions Important to Women

• Gender-specific conditions from CCS• Reviewed list of conditions from

VA’s National Women’s Health Project.

• Reviewed by a panel of physicians• Based on numbers of similarity,

collapsed some conditions, especially CCS for tractability.

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Methods: Female-Specific Conditions

• Menopausal disorders• Inflammatory female pelvic disorders• Menstrual disorders• Other female genital disorders• Pregnancy• Infertility• Contraceptive management• Benign female pelvic neoplasms• Nonmalignant breast conditions• Female pelvic malignancies• Breast cancer

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Methods: Male-Specific Conditions

• Two conditions from the original list were identified as male-specific conditions

–Prostatic hypertrophy

–Prostate cancer

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Methods: Determination of Medical Care Cost (1)

• Annual costs include:– Inpatient care: Med/Surg and all

other costs

–Outpatient care

–Outpatient prescription drugs

–Does not include non-VA providers

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Methods: Determination of Medical Care Cost (2)

• All data from HERC person-level cost files– Inpatient and Outpatient care costs

determined using HERC Average Cost Database–Outpatient prescription drug costs

reported by the VA Decision Support System (DSS) National Data Extract

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Methods: Determination of Veteran’s Status

• All VA PTF and NPCD records indicate veteran status.

–Check for agreement across records; found very high agreement

–Created categorical variable to identify veteran’s vs. non-veteran’s

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VA Users, By Gender and Veteran’s Status

Male Female

Veteran 3,940,148 178,463

Non-Veteran 129,470 185,040

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Eligibility of Non-Veteran Female Users of VA Care, N=185,040

• 106,412 employees

• 25,283 VA sharing agreements

• 19,764 collaterals (eligible family members)

• 15,154 CHAMPVA

• 10,513 TriCare

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Age Distributions of Female and Male Veterans Who Used VA in FY 2002

Women Men

Age (%) N=178,463 N=3,940,148

<45 42.5 9.4

45-54 25.8 18.0

55-64 10.0 20.1

65-74 7.1 26.3

75+ 14.6 26.2

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Race/Ethnicity Distribution of Female and Male Veterans Who Used VA in FY 2002

Women Men

Race/Ethnicity (%)

N=178,463 N=3,940,148

White 39.6 42.9

Black 13.4 9.0

Hispanic 1.9 3.4

Other 0.6 0.5

Unknown 44.6 44.2

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Marital Status of Female and Male Veterans Who Used VA in FY 2002

Women Men

Marital Status (%)

N=178,463 N=3,940,148

Married 34.1 60.8

Divorced 27.6 18.3

Widowed 9.6 6.8

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VA Eligibility of Female and Male Veterans Who Used VA in FY 2002

Women Men

VA Eligibility (%) N=178,463 N=3,940,148

Cat A, service connected

42.2 30.9

Cat A, non-service connected

36.2 40.0

Category C 16.3 26.3

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Frequency and Age-Adjusted Odds Ratios By Gender, VA Users FY 2002

Cardio- Women Men Age-Adj

vascular N=178,463 N=3,940,148 OR

Hypertension 28.6 48.9 0.65

Ischemic 5.5 20.4 0.38

CHF 1.6 4.5 0.59

Peri Vas Dis 1.3 4.4 0.49

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Women Men Age-Adj

N=178,463 N=3,940,148 OR

COPD 4.4 10.0 0.65

Asthma 6.2 2.5 2.35

Acid disorders

3.1 3.7 0.90

Hepatitis C 1.3 2.1 0.32

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Women Men Age-Adj

N=178,463 N=3,940,148 OR

Low back 15.8 11.6 1.10

Arthritis 16.6 17.8 1.08

Injury 12.6 8.1 1.27

Osteoporosis 5.5 0.8 13.64

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Women Men Age-Adj

N=178,463 N=3,940,148 OR

Stroke 1.0 2.2 0.68

MS 0.9 0.3 2.51

Headache 17.8 2.6 5.59

Dementia 0.7 1.2 1.15

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Women Men Age-Adj

N=178,463 N=3,940,148 OR

Depression 22.8 11.5 1.69

PTSD 6.7 5.1 0.88

Schizophrenia 3.0 2.4 0.76

Bipolar 4.4 1.7 1.62

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Women Men Age-Adj

N=178,463 N=3,940,148 OR

Paranoid 1.3 1.2 0.90

Personality 2.4 0.7 1.93

Substance 11.7 13.4 0.54

Other psych 31.7 20.8 1.33

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Summary Women Men Age-Adj

N=178,463 N=3,940,148 OR

Any medical 65.6 77.9 0.81

Male 14.5

Female 31.6

Mental Health

38.0 29.9 1.01

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Summarization of Utilization and Costs

• Aggregated the chronic/clinical conditions into four groups

–No medical or mental health conditions

–Medical conditions only

–Mental health conditions only

– Both medical and mental health conditions

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Distributions of Women and Men Veterans By Health Conditions

None Medical Mental Health

Both

Women 43,560 67,010 17,748 50,145

Men 640,627 2,119,981 228,211 951,329

Age

Women 43.8 56.0 42.5 50.4

Men 59.5 67.2 52.7 60.9

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VA Utilization By Women and Men Veterans, By Health Conditions


Both

Num OP

Women 5.1 13.7 15.5 31.9

Men 4.2 12.7 16.6 27.4

Num IP

Women 1.21 0.94 2.53 3.50

Men 2.58 1.37 4.67 4.62

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Inpatient VA Utilization By Women and Men Veterans, By Health Conditions


Both

Med/Surg

Women 0.11 0.43 0.11 0.69

Men 0.28 0.68 0.24 1.09

MH/SA

Women 0.05 0.00 1.26 0.99

Men 0.11 0.01 1.74 0.86

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Total Annual VA Costs for Women and Men Veterans, By Health Conditions


Both

Women 1,422 3,159 3,640 7,279

(8,534) (8,774) (10,450) (13,769)

Men 2,128 3,756 4,391 7,557

(14,001) (11,715) (13,206) (15,647)

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Total Inpatient VA Costs for Women and Men Veterans, By Health Conditions


Both

Women 649 1,028 1,451 2,570

Men 1,456 1,622 2,299 3,4369

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Total Outpatient VA Costs for Women and Men Veterans, By Health Conditions


Both

Women 614 1,416 1,525 3,242

Men 503 1,337 1,523 2,808

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Total VA Pharmacy Costs for Women and Men Veterans, By Health Conditions


Both

Women 158 715 663 1,468

Men 170 797 568 1,313

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Conclusions

• Women veterans have different disease profiles, even after adjusting for age

• Women have more mental health conditions, but not on an age-adjusted basis

• Women veterans use more outpatient, and less inpatient care than men veterans

• Use of care varies greatly by condition

Documents

Disease Burden, Utilization and Costs of Care Among Women Using Veterans Health Administration HERC Cyber Seminar May 25, 2005 Presented by Ciaran Phibbs