Nonacute Utilization of Department of Veterans Affairs Inpatient Services: Background and Design of a Nationwide Study

Department of Veterans Affairs Medical Centers (VAMCs), as well as the nation's private sector hospitals, are under increasing pressure to ensure that limited resources are used effectively and efficiently to provide the highest possible quality of care. To address this issue, the Iowa Health Services Research and Development (HSR&D) Field Program conducted a nationwide study to 1) estimate the magnitude of care (admissions and days of hospitalization) currently being provided in the inpatient setting that could potentially be provided in alternative, less service-intensive and lower cost settings, such as at the outpatient or long-term care levels, and 2) identify possible reasons for the nonacute care. The medical records of a stratified random sample of 6,063 fiscal year 1986 medical/surgical hospitalizations from 50 VAMCs were retrospectively reviewed using the Appropriateness Evaluation Protocol. Estimated rates of nonacute admissions and days of stay generalizable to the 136 VAMCs providing both medicine and surgery services were developed. This article discusses the background of the study, the sampling design for selecting VAMCs and hospitalizations, and the medical record review process for assessing nonacute care. Subsequent reports present the estimated rates of nonacute admissions and days of care and possible reasons for the nonacute utilization.