Dual Use and Hospital Admissions among Veterans Enrolled in the 's Homeless Patient Aligned Care Team

Objective

To examine the association between reliance on outpatient care and hospital admissions among Medicare‐eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H‐).

Data Sources/Study Setting

Registry of H‐ enrollees linked to and Medicare utilization data for 2013.

Study Design

After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in (higher reliance) or <90 percent of outpatient care in (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and ‐financed hospital admissions.

Principal Findings

Compared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual hospitalizations (0.63 vs. 0.50;  = .14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08;  < .001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of hospital use but over 10‐fold greater rates of Medicare‐financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance;  < .001).

Conclusions

Among Veterans receiving integrated care in 's H‐, dual use of Medicare and outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking and non‐ data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.