Variation in Low-Value Service Use Across Veterans Affairs Facilities
Background It is unclear whether extensive variation in the use of low-value services exists even within a national integrated delivery system like the Veterans Health Administration (VA). Objective To quantify variation in the use of low-value services across VA facilities and examine associations...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2023-08, Vol.38 (10), p.2245-2253 |
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| creator | Schwartz, Aaron L. Zhao, Xinhua Sileanu, Florentina E. Lovelace, Elijah Z. Rose, Liam Radomski, Thomas R. Thorpe, Carolyn T. |
| description | Background
It is unclear whether extensive variation in the use of low-value services exists even within a national integrated delivery system like the Veterans Health Administration (VA).
Objective
To quantify variation in the use of low-value services across VA facilities and examine associations between facility characteristics and low-value service use.
Design
In this retrospective cross-sectional study of VA administrative data, we constructed facility-level rates of low-value service use as the mean count of 29 low-value services per 100 Veterans per year. Adjusted rates were calculated via ordinary least squares regression including covariates for Veteran sociodemographic and clinical characteristics. We quantified the association between adjusted facility-level rates and facility geographic/operational characteristics.
Participants
5,242,301 patients across 139 VA facilities.
Main Measures
Use of 29 low-value services within six domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and surgery.
Key Results
The mean rate of low-value service use was 20.0 services per 100 patients per year (S.D. 6.1). Rates ranged from 13.9 at the 10
th
percentile to 27.6 at the 90
th
percentile (90
th
/10
th
percentile ratio 2.0, 95% CI 1.8‒2.3). With adjustment for patient covariates, variation across facilities narrowed (S.D. 5.2, 90
th
/10
th
percentile ratio 1.8, 95% CI 1.6‒1.9). Only one facility characteristic was positively associated with low-value service use percent of patients seeing non-VA clinicians via VA Community Care,
p
|
| doi_str_mv | 10.1007/s11606-023-08157-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10406760</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2791375041</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-1949e7fe1012d9cf104c0552f855667366ca91083eea586f7528bc0db7e9741c3</originalsourceid><addsrcrecordid>eNp9kT1vFDEQhi1ERI6EP0CBVqKhMcx4_VmhU5QEpJMoklxr-XyzwdHebrB3g_j3OLkQPgoqF_PMO555GHuN8B4BzIeCqEFzEC0Hi8pw94wtUAnFUTrznC3AWsmtaeUhe1nKDQC2QtgX7LDVTksp1IKdrkNOYUrj0KShWY3f-Tr0MzUXlO9SpOaqULOMeSylWdNEOQylWXZdSLk0ZyGmPk2JyjE76EJf6NXje8Suzk4vTz7x1ZfzzyfLFY_SqImjk45MRwgoti52CDKCUqKzSmltWq1jcAi2JQrK6s4oYTcRthtDzkiM7RH7uM-9nTc72kYaphx6f5vTLuQffgzJ_10Z0ld_Pd75Ogm00VAT3j0m5PHbTGXyu1Qi9X0YaJyLF8ZhaxRIrOjbf9Cbcc5D3c8LKw0qBU5XSuyphyNl6p5-g-DvNfm9Jl81-QdN3tWmN3_u8dTyy0sF2j1Qamm4pvx79n9ifwLz55xh</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2847155096</pqid></control><display><type>article</type><title>Variation in Low-Value Service Use Across Veterans Affairs Facilities</title><source>PubMed Central Free</source><source>MEDLINE</source><source>SpringerNature Journals</source><source>Alma/SFX Local Collection</source><source>EZB Electronic Journals Library</source><creator>Schwartz, Aaron L. ; Zhao, Xinhua ; Sileanu, Florentina E. ; Lovelace, Elijah Z. ; Rose, Liam ; Radomski, Thomas R. ; Thorpe, Carolyn T.</creator><creatorcontrib>Schwartz, Aaron L. ; Zhao, Xinhua ; Sileanu, Florentina E. ; Lovelace, Elijah Z. ; Rose, Liam ; Radomski, Thomas R. ; Thorpe, Carolyn T.</creatorcontrib><description>Background
It is unclear whether extensive variation in the use of low-value services exists even within a national integrated delivery system like the Veterans Health Administration (VA).
Objective
To quantify variation in the use of low-value services across VA facilities and examine associations between facility characteristics and low-value service use.
Design
In this retrospective cross-sectional study of VA administrative data, we constructed facility-level rates of low-value service use as the mean count of 29 low-value services per 100 Veterans per year. Adjusted rates were calculated via ordinary least squares regression including covariates for Veteran sociodemographic and clinical characteristics. We quantified the association between adjusted facility-level rates and facility geographic/operational characteristics.
Participants
5,242,301 patients across 139 VA facilities.
Main Measures
Use of 29 low-value services within six domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and surgery.
Key Results
The mean rate of low-value service use was 20.0 services per 100 patients per year (S.D. 6.1). Rates ranged from 13.9 at the 10
th
percentile to 27.6 at the 90
th
percentile (90
th
/10
th
percentile ratio 2.0, 95% CI 1.8‒2.3). With adjustment for patient covariates, variation across facilities narrowed (S.D. 5.2, 90
th
/10
th
percentile ratio 1.8, 95% CI 1.6‒1.9). Only one facility characteristic was positively associated with low-value service use percent of patients seeing non-VA clinicians via VA Community Care,
p
< 0.05); none was associated with total low-value service use after adjustment for other facility characteristics. There was extensive variation in low-value service use within categories of facility operational characteristics.
Conclusions
Despite extensive variation in the use of low-value services across VA facilities, we observed substantial use of these services across facility operational characteristics and at facilities with lower rates of low-value service use. Thus, system-wide interventions to address low-value services may be more effective than interventions targeted to specific facilities or facility types.</description><identifier>ISSN: 0884-8734</identifier><identifier>ISSN: 1525-1497</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-023-08157-9</identifier><identifier>PMID: 36964425</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Cancer screening ; Community health care ; Cross-Sectional Studies ; Delivery of Health Care, Integrated ; Humans ; Internal Medicine ; Least squares method ; Medical screening ; Medicine ; Medicine & Public Health ; Original Research ; Patients ; Retrospective Studies ; United States - epidemiology ; United States Department of Veterans Affairs ; Variation ; Veterans</subject><ispartof>Journal of general internal medicine : JGIM, 2023-08, Vol.38 (10), p.2245-2253</ispartof><rights>This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023</rights><rights>2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.</rights><rights>This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2023.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-1949e7fe1012d9cf104c0552f855667366ca91083eea586f7528bc0db7e9741c3</citedby><cites>FETCH-LOGICAL-c475t-1949e7fe1012d9cf104c0552f855667366ca91083eea586f7528bc0db7e9741c3</cites><orcidid>0000-0002-8583-1369</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406760/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10406760/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,41488,42557,51319,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36964425$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwartz, Aaron L.</creatorcontrib><creatorcontrib>Zhao, Xinhua</creatorcontrib><creatorcontrib>Sileanu, Florentina E.</creatorcontrib><creatorcontrib>Lovelace, Elijah Z.</creatorcontrib><creatorcontrib>Rose, Liam</creatorcontrib><creatorcontrib>Radomski, Thomas R.</creatorcontrib><creatorcontrib>Thorpe, Carolyn T.</creatorcontrib><title>Variation in Low-Value Service Use Across Veterans Affairs Facilities</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
It is unclear whether extensive variation in the use of low-value services exists even within a national integrated delivery system like the Veterans Health Administration (VA).
Objective
To quantify variation in the use of low-value services across VA facilities and examine associations between facility characteristics and low-value service use.
Design
In this retrospective cross-sectional study of VA administrative data, we constructed facility-level rates of low-value service use as the mean count of 29 low-value services per 100 Veterans per year. Adjusted rates were calculated via ordinary least squares regression including covariates for Veteran sociodemographic and clinical characteristics. We quantified the association between adjusted facility-level rates and facility geographic/operational characteristics.
Participants
5,242,301 patients across 139 VA facilities.
Main Measures
Use of 29 low-value services within six domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and surgery.
Key Results
The mean rate of low-value service use was 20.0 services per 100 patients per year (S.D. 6.1). Rates ranged from 13.9 at the 10
th
percentile to 27.6 at the 90
th
percentile (90
th
/10
th
percentile ratio 2.0, 95% CI 1.8‒2.3). With adjustment for patient covariates, variation across facilities narrowed (S.D. 5.2, 90
th
/10
th
percentile ratio 1.8, 95% CI 1.6‒1.9). Only one facility characteristic was positively associated with low-value service use percent of patients seeing non-VA clinicians via VA Community Care,
p
< 0.05); none was associated with total low-value service use after adjustment for other facility characteristics. There was extensive variation in low-value service use within categories of facility operational characteristics.
Conclusions
Despite extensive variation in the use of low-value services across VA facilities, we observed substantial use of these services across facility operational characteristics and at facilities with lower rates of low-value service use. Thus, system-wide interventions to address low-value services may be more effective than interventions targeted to specific facilities or facility types.</description><subject>Cancer screening</subject><subject>Community health care</subject><subject>Cross-Sectional Studies</subject><subject>Delivery of Health Care, Integrated</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Least squares method</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Research</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>United States - epidemiology</subject><subject>United States Department of Veterans Affairs</subject><subject>Variation</subject><subject>Veterans</subject><issn>0884-8734</issn><issn>1525-1497</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kT1vFDEQhi1ERI6EP0CBVqKhMcx4_VmhU5QEpJMoklxr-XyzwdHebrB3g_j3OLkQPgoqF_PMO555GHuN8B4BzIeCqEFzEC0Hi8pw94wtUAnFUTrznC3AWsmtaeUhe1nKDQC2QtgX7LDVTksp1IKdrkNOYUrj0KShWY3f-Tr0MzUXlO9SpOaqULOMeSylWdNEOQylWXZdSLk0ZyGmPk2JyjE76EJf6NXje8Suzk4vTz7x1ZfzzyfLFY_SqImjk45MRwgoti52CDKCUqKzSmltWq1jcAi2JQrK6s4oYTcRthtDzkiM7RH7uM-9nTc72kYaphx6f5vTLuQffgzJ_10Z0ld_Pd75Ogm00VAT3j0m5PHbTGXyu1Qi9X0YaJyLF8ZhaxRIrOjbf9Cbcc5D3c8LKw0qBU5XSuyphyNl6p5-g-DvNfm9Jl81-QdN3tWmN3_u8dTyy0sF2j1Qamm4pvx79n9ifwLz55xh</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Schwartz, Aaron L.</creator><creator>Zhao, Xinhua</creator><creator>Sileanu, Florentina E.</creator><creator>Lovelace, Elijah Z.</creator><creator>Rose, Liam</creator><creator>Radomski, Thomas R.</creator><creator>Thorpe, Carolyn T.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8583-1369</orcidid></search><sort><creationdate>20230801</creationdate><title>Variation in Low-Value Service Use Across Veterans Affairs Facilities</title><author>Schwartz, Aaron L. ; Zhao, Xinhua ; Sileanu, Florentina E. ; Lovelace, Elijah Z. ; Rose, Liam ; Radomski, Thomas R. ; Thorpe, Carolyn T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-1949e7fe1012d9cf104c0552f855667366ca91083eea586f7528bc0db7e9741c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Cancer screening</topic><topic>Community health care</topic><topic>Cross-Sectional Studies</topic><topic>Delivery of Health Care, Integrated</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Least squares method</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Research</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>United States - epidemiology</topic><topic>United States Department of Veterans Affairs</topic><topic>Variation</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schwartz, Aaron L.</creatorcontrib><creatorcontrib>Zhao, Xinhua</creatorcontrib><creatorcontrib>Sileanu, Florentina E.</creatorcontrib><creatorcontrib>Lovelace, Elijah Z.</creatorcontrib><creatorcontrib>Rose, Liam</creatorcontrib><creatorcontrib>Radomski, Thomas R.</creatorcontrib><creatorcontrib>Thorpe, Carolyn T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest Healthcare Administration Database</collection><collection>PML(ProQuest Medical Library)</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwartz, Aaron L.</au><au>Zhao, Xinhua</au><au>Sileanu, Florentina E.</au><au>Lovelace, Elijah Z.</au><au>Rose, Liam</au><au>Radomski, Thomas R.</au><au>Thorpe, Carolyn T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variation in Low-Value Service Use Across Veterans Affairs Facilities</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>38</volume><issue>10</issue><spage>2245</spage><epage>2253</epage><pages>2245-2253</pages><issn>0884-8734</issn><issn>1525-1497</issn><eissn>1525-1497</eissn><abstract>Background
It is unclear whether extensive variation in the use of low-value services exists even within a national integrated delivery system like the Veterans Health Administration (VA).
Objective
To quantify variation in the use of low-value services across VA facilities and examine associations between facility characteristics and low-value service use.
Design
In this retrospective cross-sectional study of VA administrative data, we constructed facility-level rates of low-value service use as the mean count of 29 low-value services per 100 Veterans per year. Adjusted rates were calculated via ordinary least squares regression including covariates for Veteran sociodemographic and clinical characteristics. We quantified the association between adjusted facility-level rates and facility geographic/operational characteristics.
Participants
5,242,301 patients across 139 VA facilities.
Main Measures
Use of 29 low-value services within six domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and surgery.
Key Results
The mean rate of low-value service use was 20.0 services per 100 patients per year (S.D. 6.1). Rates ranged from 13.9 at the 10
th
percentile to 27.6 at the 90
th
percentile (90
th
/10
th
percentile ratio 2.0, 95% CI 1.8‒2.3). With adjustment for patient covariates, variation across facilities narrowed (S.D. 5.2, 90
th
/10
th
percentile ratio 1.8, 95% CI 1.6‒1.9). Only one facility characteristic was positively associated with low-value service use percent of patients seeing non-VA clinicians via VA Community Care,
p
< 0.05); none was associated with total low-value service use after adjustment for other facility characteristics. There was extensive variation in low-value service use within categories of facility operational characteristics.
Conclusions
Despite extensive variation in the use of low-value services across VA facilities, we observed substantial use of these services across facility operational characteristics and at facilities with lower rates of low-value service use. Thus, system-wide interventions to address low-value services may be more effective than interventions targeted to specific facilities or facility types.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36964425</pmid><doi>10.1007/s11606-023-08157-9</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8583-1369</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2023-08, Vol.38 (10), p.2245-2253 |
| issn | 0884-8734 1525-1497 1525-1497 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10406760 |
| source | PubMed Central Free; MEDLINE; SpringerNature Journals; Alma/SFX Local Collection; EZB Electronic Journals Library |
| subjects | Cancer screening Community health care Cross-Sectional Studies Delivery of Health Care, Integrated Humans Internal Medicine Least squares method Medical screening Medicine Medicine & Public Health Original Research Patients Retrospective Studies United States - epidemiology United States Department of Veterans Affairs Variation Veterans |
| title | Variation in Low-Value Service Use Across Veterans Affairs Facilities |
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