Abstract
Objectives Readmission and mortality among elderly patients admitted to inpatient care are critical outcome measures for healthcare systems. While the Veterans Health Administration (VA) has long made national administrative databases available for health services research, the HMORN Virtual Data Warehouse (VDW) at Scott & White (SWHP) has only been developed in the past year. The current study sought to utilize both data sources while examining outcomes of hospitalization for community-acquired pneumonia (CAP) in two systems of care in the same geographic region.
Methods Patients >65 years of age hospitalized with CAP (ICD9 codes 480–483, 485–487) in Central Texas in VA fiscal year 2009 (Oct 2008–Sep 2009) were identified. Dates of care and inpatient death were sought to determine outcomes subsequent to CAP admission. Covariates included sociodemographic measures (such as age, gender) and comorbidity.
Results There were 469 SWHP CAP patients and 152 VA CAP patients admitted in the year studied. The SWHP fiscal year differed from the VA fiscal year, potentially complicating the work of the SWHP data team. VA CAP patients averaged 77.2 years (SD 7.6), were 96% male, and experienced an inpatient death rate of 18%. SWHP CAP patients averaged 81.6 years (SD 8.2), and 56% were women. Date of death as an inpatient was not explicitly available in VDW data. Patients in the two systems varied significantly as VA patients were more likely to be male and younger.
Conclusions Patients in the federal VA system can be studied in conjunction with private-care patients in the same catchment area using newly available VDW data. The data presented required two teams of data analyst/programmers, one working within the VA system and the other working within the SWHP VDW system. Coordination was facilitated by the VDW Site Director Godwin working together with the jointly appointed VA/SWHP investigator Copeland. Sharing SAS code between VDW and VA programmers helped to lend consistency to the data analytic approaches across systems. Adjusted analyses employing high-dimensional propensity scores could be employed to assess whether inter-system differences in CAP-related outcomes can be validly estimated.
