Geographic, Patient, and VA Medical Center Variation in the Receipt and Mode of Primary Care in a National Sample of Veterans with Diabetes during 2020
Abstract
:1. Introduction
2. Materials and Methods
3. Results
Spatial Variation across Catchment Areas
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Overall | Social Vulnerability Q1 | Social Vulnerability Q2 | Social Vulnerability Q3 | Social Vulnerability Q4 | ||
---|---|---|---|---|---|---|
n | 1,647,158 | 316,086 | 452,403 | 484,048 | 392,783 | |
Age (Mean (SD)) | 69.89 (11.32) | 71.10 (11.54) | 70.27 (11.44) | 69.69 (11.21) | 68.73 (10.99) | |
Male | 95.14 | 95.90 | 95.37 | 95.00 | 94.41 | |
Race | ||||||
non-Hispanic White | 72.50 | 83.53 | 80.50 | 73.76 | 52.90 | |
non-Hispanic Black | 21.61 | 12.58 | 14.90 | 20.74 | 37.79 | |
Hispanic | 5.89 | 3.89 | 4.60 | 5.50 | 9.31 | |
Rural | 37.43 | 27.53 | 39.80 | 45.54 | 32.62 | |
Married | 59.98 | 67.66 | 63.85 | 59.51 | 49.94 | |
Service-Connected Disability ≥ 50 | 37.60 | 38.42 | 38.43 | 38.05 | 35.45 | |
van Walraven Comorbidity Score(Mean (SD)) | 4.16 (7.69) | 4.06 (7.39) | 4.08 (7.51) | 4.17 (7.69) | 4.32 (8.09) | |
Medications | ||||||
No Medications | ||||||
Orals | 34.21 | 33.41 | 34.20 | 34.63 | 34.36 | |
Insulin | 8.80 | 8.83 | 8.65 | 8.77 | 8.99 | |
Orals and Insulin | 24.67 | 22.45 | 23.82 | 25.18 | 26.77 | |
HbA1c in 2019 (Mean (SD)) | 7.20 (1.42) | 7.13 (11.54) | 7.17 (1.37) | 7.21 (1.43) | 7.25 (1.54) | |
VAMC Telehealth Visits FY19 | ||||||
Quartile 1 (highest proportion > 28%) | 24.49 | 23.06 | 22.32 | 24.50 | 28.17 | |
Quartile 2 (23–28% telehealth) | 21.53 | 22.48 | 20.49 | 20.52 | 23.36 | |
Quartile 3 (16–22% telehealth) | 26.09 | 27.92 | 28.50 | 25.65 | 22.27 | |
Quartile 4 (lowest proportion < 16%) | 27.89 | 26.53 | 28.70 | 29.34 | 26.19 |
In-Person Primary Care | Tele-Primary Care | ||
---|---|---|---|
Age (1 year) | 0.99 (0.99, 0.99) | 0.99 (0.99, 0.99) | |
Male (female) | 0.78 (0.77, 0.79) | 0.77 (0.76, 0.79) | |
Race | |||
non-Hispanic White | 1.00 | 1.00 | |
non-Hispanic Black | 0.81 (0.81, 0.82) | 1.21 (1.20, 1.22) | |
Hispanic | 0.89 (0.88, 0.90) | 1.16 (1.14, 1.18) | |
Rural (Urban) | 1.10 (1.09, 1.11) | 0.91 (0.90, 0.92) | |
Married (not married) | 1.00 (0.98, 1.00) | 0.94 (0.93, 0.95) | |
Service-Connected Disability ≥ 50 | 1.20 (1.22, 1.24) | 1.24 (1.23, 1.26) | |
van Walraven Comorbidity Score | 1.01 (1.01, 1.01) | 1.01 (1.01, 1.01) | |
Medications | |||
No Medications | 1.00 | 1.00 | |
Orals | 1.43 (1.61, 1.63) | 1.39 (1.38, 1.41) | |
Insulin | 1.26 (1.29, 1.32) | 1.40 (1.38, 1.41) | |
Orals and Insulin | 1.77 (1.75, 1.78) | 1.82 (1.80, 1.84) | |
Mean HbA1c in 2019 | 0.94 (0.93, 0.94) | 0.95 (0.95, 0.95) | |
CDC Social Vulnerability Index | |||
Quartile 1 (Least vulnerable) | 1.00 | 1.00 | |
Quartile 2 | 1.01 (1.00, 1.02) | 1.07 (1.06, 1.08) | |
Quartile 3 | 0.98 (0.97, 0.99) | 1.18 (1.17, 1.20) | |
Quartile 4 (Most vulnerable) | 0.96 (0.94, 0.97) | 1.27 (1.26, 1.29) | |
VAMC Telehealth Visits FY19 | |||
Quartile 1 (highest proportion > 28%) | 1.00 | 1.00 | |
Quartile 2 (23–28% telehealth) | 0.91 (0.90, 0.92) | 0.71 (0.71, 0.72) | |
Quartile 3 (16–22% telehealth) | 0.99 (0.99, 1.00) | 0.56 (0.55, 0.57) | |
Quartile 4 (lowest proportion < 16%) | 0.93 (0.92, 0.94) | 0.39 (0.39, 0.39) | |
Spatial Variation | 0.59 | 0.70 |
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Davis, M.; Neelon, B.; Pearce, J.L.; Medunjanin, D.; Bast, E.; Axon, R.N.; Florez, H.; Hunt, K.J. Geographic, Patient, and VA Medical Center Variation in the Receipt and Mode of Primary Care in a National Sample of Veterans with Diabetes during 2020. Healthcare 2024, 12, 643. https://doi.org/10.3390/healthcare12060643
Davis M, Neelon B, Pearce JL, Medunjanin D, Bast E, Axon RN, Florez H, Hunt KJ. Geographic, Patient, and VA Medical Center Variation in the Receipt and Mode of Primary Care in a National Sample of Veterans with Diabetes during 2020. Healthcare. 2024; 12(6):643. https://doi.org/10.3390/healthcare12060643
Chicago/Turabian StyleDavis, Melanie, Brian Neelon, John L. Pearce, Danira Medunjanin, Elizabeth Bast, Robert Neal Axon, Hermes Florez, and Kelly J. Hunt. 2024. "Geographic, Patient, and VA Medical Center Variation in the Receipt and Mode of Primary Care in a National Sample of Veterans with Diabetes during 2020" Healthcare 12, no. 6: 643. https://doi.org/10.3390/healthcare12060643