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State of Care for Veterans with Chronic
Chapter 3 - Services Provided to Veterans with Chronic HCV
The 147,352 Veterans with chronic HCV in VHA care in 2008 generated over 60,000 inpatient stays, over 5 million outpatient visits and over 5.3 million prescription fills. Compared to data from fiscal year 2008 for the overall VHA population, Veterans with chronic HCV had higher use of some VHA services including hospitalizations and outpatient visits (Table 1).
|Veterans with Chronic HCV CY 2008||All Veterans in Care FY 2008|
* Includes acute and non-acute discharges. Abbreviations: CY calendar year; FY, federal fiscal year
|Number of Veterans||147,352||5.6 million|
|Inpatient Discharges (#/1000 Veterans)*||410||115|
|Outpatient Visits (#/1000 Veterans)||33,932||11,982|
|Prescription Fills (#/1000 Veterans)||35,968||43,661|
Over twenty thousand (23,762) Veterans with chronic HCV had one or more of the 60,359 inpatient discharges in 2008. Their average length of stay was 17.9 days with a median of 5 days. Mental health diagnoses were the most common primary inpatient diagnosis at 19.5% for Veterans with chronic HCV and 14% for the general VHA population (Table 2). Compared with the overall VHA population, Veterans with chronic HCV had a higher percent of discharges for diseases of the digestive system (11.9% vs. 8.4%) and substance use disorders (14% vs. 6.1%). The general VHA population had a higher percentage of hospitalizations for diseases of the circulatory system than Veterans with chronic HCV at 18.7% versus 9.7%, respectively. The percentage of discharges with a primary diagnosis of cirrhosis was 4.4% in Veterans with chronic HCV compared to 0.9% of the general population of Veterans nationwide. With one exception, there was little difference in incidence of primary discharge diagnosis between 2005 and 2008 for Veterans with chronic HCV. The exception is that substance use disorder among Veterans with chronic HCV decreased from 18% of all primary discharges in 2005 to 14% in 2008.
|Major Diagnostic Group||Veterans with Chronic HCV CY 2005*||Veterans with Chronic HCV CY 2008*||All Veterans FY 2008*|
* Percent of all discharges in that year. Subgroups with at least 1% in any year are presented and ranked by Veterans with chronic HCV in CY 2008
** Includes discharges for signs and symptoms including fever, shortness of breath, fainting and other symptoms requiring evaluation and observation.
*** Includes discharges related to prosthetic or orthopedic aftercare and rehabilitation.
Abbreviations: CY, calendar year; FY, fiscal year
|Substance Use and Disorders||18.0%||14.0%||6.1%|
|Diseases of the Digestive System||11.3%||11.9%||8.4%|
|Diseases of the Circulatory System||9.2%||9.7%||18.7%|
|Signs and Symptoms**||6.9%||6.7%||7.0%|
|Diseases of the Respiratory System||4.9%||5.6%||8.4%|
|Health Status Factors***||3.2%||4.9%||5.2%|
|Injury, Poisoning, Drug Toxicity||5.2%||4.9%||4.9%|
|Diseases of the Musculoskeletal System and Connective Tissue||2.8%||3.2%||4.2%|
|Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders||3.3%||3.2%||3.5%|
|Diseases of the Skin and Subcutaneous Tissue||3.2%||2.8%||2.5%|
|Kidney and Urinary Tract||2.2%||2.8%||4.2%|
|Infectious and Parasitic Diseases||2.2%||2.6%||1.6%|
|Diseases of the Nervous System and Sense Organs||1.3%||1.7%||2.4%|
|Diseases of the Blood and Blood-Forming Organs||0.9%||1.3%||1.4%|
With regard to outpatient care, depending on the local healthcare system, Veterans with chronic HCV may be seen for their HCV infection in Gastrointestinal (GI), Hepatology, Primary Care, or a combination of these clinics. Veterans with chronic HCV were actively engaged in VHA care; in 2008; 52% of Veterans had between 2 and 6 visits to GI clinic, Hepatology, or Primary Care, 20% had between 7 and 12 visits, 8% had 13 visits or more, while 20% had one visit or less (Figure 7).
The numbers of prescription fills for Veterans with chronic HCV were lower than those without chronic HCV. The cost of antiviral therapy and the management of associated toxicities likely results in higher overall prescription costs per Veteran with chronic HCV. This increased cost is contrasted with the potential for cost avoidance associated with prevention of progression of liver disease and early death. With new, more effective treatments for chronic HCV on the near horizon, it will be important for healthcare administrators to understand the overall cost impact of chronic HCV care over the next two decades.
- VHA data. The data on the entire Veteran population can be found at http://www1.va.gov/vetdata.
- Major Diagnostic Group. The distribution of admissions by major diagnostic group was determined using the primary discharge code for each hospitalization categorized by the 17 groups created by the Classification of Diseases and Injuries version ICD-9-CM. Distribution of discharges for the National VA population is based on data from the VA.s Decision Support System.
- Outpatient Visits. Only one visit is counted for a Veteran for each clinic and date of visit even if multiple practitioners (i.e. nurse practitioner and physician) saw a given patient.