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Although alcohol problems are common in human immunodeficiency virus (HIV)-infected patients, their impact on health care services use in HIV-infected patients is not well understood.We sought to examine the association between alcohol problems and health care services use in HIV-infected and HIV-uninfected patients.We undertook a prospective analysis of 16,048 HIV-infected veterans and 32,096 age-, race-, gender-, and region-matched HIV-uninfected controls identified through the national Veterans Affairs electronic administrative medical record database. We identified subjects with alcohol problems using ICD-9-CM codes for alcohol diagnoses and/or alcohol-related complications.We measured outpatient visits, emergency department visits, and inpatient hospitalizations over 12 months of follow-up.In adjusted analyses, HIV-infected veterans with alcohol problems were significantly more likely than HIV-uninfected veterans without alcohol problems to have at least 1 outpatient visit and at least 1 inpatient hospitalization and, among those with any health services use, to have significantly greater rates for outpatient visits (Incidence rate ratio [IRR] 2.17; 95% confidence interval [CI] 2.06-2.28; P < 0.001), emergency department visits (IRR 1.46; 95% CI 1.35-1.58; P < 0.001), and inpatient hospitalizations (IRR 1.46; 95% CI 1.30-1.64; P < 0.001). The incidence rates for outpatient visits, mental health visits, emergency department visits, and inpatient hospitalizations were significantly higher in HIV-infected veterans with alcohol problems than in HIV-infected veterans without alcohol problems. We did not find a consistent interaction effect between alcohol problems and HIV status.Alcohol problems are associated with greater outpatient, emergency department, and inpatient health care utilization in HIV-infected and HIV-uninfected veterans. However, alcohol does not appear to have a stronger effect on health services use in HIV-infected veterans compared with HIV-uninfected veterans. [ABSTRACT FROM AUTHOR]

Objective: Metabolic decompensations (MD) are hospitalizations considered preventable with appropriate ambulatory care. We tested for associations between diabetes care and MD., Research Design: We retrospectively compared care between cases (MD; n = 2714) and controls (without MD; n = 10,856) using merged Veterans Health Administration and Medicare data. Logistic regression tested for associations between MD and diabetes care controlling for patient characteristics., Subjects: Veterans Health Administration users with diabetes stratified into high [hemoglobin A1c (HA1c) > or =9%; n = 2532] and low (HA1c <9%; n = 6176) risk groups., Measures: The outcome was hospitalization for MD. Care was defined as quarterly or semiannual diabetes visits and HA1c testing during individualized 12-month baseline periods., Results: : Cases averaged more diabetes visits and HA1c tests than controls (P < 0.001 for both) in the 12-month baseline period. Among the high-risk, 29.8% of cases made 4 quarterly visits compared with 29.6% of controls (P = 0.004); among the low-risk, there was no difference in semiannual visits. Among the high-risk, models showed having no visit was associated with higher odds of MD (adjusted odds ratio: 3.05; 95% confidence interval: 1.69-5.49) compared with 4 visits; individuals with 1-4 visits had similar odds of MD. More HA1c testing was weakly associated with higher odds of MD., Conclusions: MD was associated with more diabetes care, even controlling for patient characteristics. This inconsistency with the theoretical association between appropriate ambulatory care and lower MD rates indicates that MD rates may not accurately reflect diabetes care quality.

Objectives: To assess the severity level of acute inpatient care in the Veterans Health Administration (VA) using the 3M All Patient Refined Diagnosis Related Groups (APR-DRGs) Grouper and compare severity levels in the six study sites with other Veterans Affairs Medical Centers., Methods: Acute inpatient stays were generated based on bedsection movement information in VA Inpatient Medical SAS data sets from federal fiscal years 1997 and 1998. All nonacute bedsections were excluded. The APR-DRG Grouper generated APR-DRG and severity level for each acute inpatient stay using relevant VA data in a fixed format. Severity and length of stay (LOS) within each major APR-DRG (those accounting for at least 0.5% of all acute inpatient stays or days) were compared between study sites and other centers using z scores., Results: Of 315 APR-DRGs, 63 major groups accounted for more than two thirds of all stays and days of care in both years. The study sites were similar in average patient severity and LOS to other centers for most APR-DRGs. For those with significant differences, the six centers had shorter LOS and higher severity. The magnitude of differences was large in LOS and small in severity., Conclusions: The study sites are generally representative of the overall VA acute inpatient stays. Some adjustments were needed to reflect that the six sites had relatively sicker patients and lower LOS in some of APR-DRGs when resource utilization estimations in the six sites were generalized to the entire VA system. The severity measure of the 3M APR-DRG Grouper can be adapted to the VA controlling for the complicated nature of VA inpatient care.