Race and Income Association with Health Service Utilization for Veterans with Heart Failure

Hdl Handle:
http://hdl.handle.net/10675.2/318832
Title:
Race and Income Association with Health Service Utilization for Veterans with Heart Failure
Authors:
Landrum, Laurie G.
Abstract:
Disproportionate heart failure outcomes exist for Blacks in the Veterans Health Administration (VHA) despite equitable access and financial barrier minmization. No study has examined the association of race and income with health service utilization for veterans with heart failure. This observational study investigated race and income associations with readmissions, bed days of care, and emergency room (ER) visits for veterans with heart failure after controlling for predisposing, enabling, and illness severity factors. Medical record data were collected for 149 veterans telemonitored for heart failure during 2008-2011. Heart failure symptoms severity and comorbidities were measured using investigator-adapted scales based on the New York Heart Association IIV scale and the Charlson comorbidity index. Heart failure related outcomes (30 day, 90 day, 1 year, and total readmissions, ER visits, and total bed days of care) were modeled controlling for age, marital status, and heart failure and comorbidity severity. Of patients younger than 60 years of age, 18% were Black compared to 11% of Whites, Χ2 (2, N=149) = 5.15, p= .02. Blacks had a much higher comorbidity prevalence than Whites, p = .000. Ischemic heart disease and chronic kidney disease rates were double and triple national VHA rates, respectively, among Whites and Blacks. Race did not predict readmissions, bed days of care, or ER visits. The odds of a readmission or bed day of care ever decreased by 38% and 43%, respectively, for married men, p = .03. The odds of a readmission or bed day of care ever due to severe heart failure—compared to less severe heart failure—were four to five times higher, respectively, p ≤ .004. Income increased the odds of total bed days of care by 14%, p = .00, holding race constant. Overall, the sample experienced far fewer readmissions, bed days of care, or ER visits, compared to VHA national rates, but sample size may have limited accurate comparisons.
Affiliation:
Department of Nursing
Issue Date:
Jul-2012
URI:
http://hdl.handle.net/10675.2/318832
Additional Links:
http://ezproxy.augusta.edu/login?url=http://search.proquest.com/docview/1082056168?accountid=12365
Type:
Dissertation
Language:
en
Appears in Collections:
Department of Biobehavioral Nursing Theses and Dissertations; Theses and Dissertations

Full metadata record

DC FieldValue Language
dc.contributor.authorLandrum, Laurie G.en
dc.date.accessioned2014-06-03T22:17:28Z-
dc.date.available2014-06-03T22:17:28Z-
dc.date.issued2012-07-
dc.identifier.urihttp://hdl.handle.net/10675.2/318832-
dc.description.abstractDisproportionate heart failure outcomes exist for Blacks in the Veterans Health Administration (VHA) despite equitable access and financial barrier minmization. No study has examined the association of race and income with health service utilization for veterans with heart failure. This observational study investigated race and income associations with readmissions, bed days of care, and emergency room (ER) visits for veterans with heart failure after controlling for predisposing, enabling, and illness severity factors. Medical record data were collected for 149 veterans telemonitored for heart failure during 2008-2011. Heart failure symptoms severity and comorbidities were measured using investigator-adapted scales based on the New York Heart Association IIV scale and the Charlson comorbidity index. Heart failure related outcomes (30 day, 90 day, 1 year, and total readmissions, ER visits, and total bed days of care) were modeled controlling for age, marital status, and heart failure and comorbidity severity. Of patients younger than 60 years of age, 18% were Black compared to 11% of Whites, Χ2 (2, N=149) = 5.15, p= .02. Blacks had a much higher comorbidity prevalence than Whites, p = .000. Ischemic heart disease and chronic kidney disease rates were double and triple national VHA rates, respectively, among Whites and Blacks. Race did not predict readmissions, bed days of care, or ER visits. The odds of a readmission or bed day of care ever decreased by 38% and 43%, respectively, for married men, p = .03. The odds of a readmission or bed day of care ever due to severe heart failure—compared to less severe heart failure—were four to five times higher, respectively, p ≤ .004. Income increased the odds of total bed days of care by 14%, p = .00, holding race constant. Overall, the sample experienced far fewer readmissions, bed days of care, or ER visits, compared to VHA national rates, but sample size may have limited accurate comparisons.en
dc.language.isoenen
dc.relation.urlhttp://ezproxy.augusta.edu/login?url=http://search.proquest.com/docview/1082056168?accountid=12365en
dc.rightsCopyright protected. Unauthorized reproduction or use beyond the exceptions granted by the Fair Use clause of U.S. Copyright law may violate federal law.-
dc.subjectveteransen
dc.subjectHeart Failureen
dc.subjectHealth Disparitiesen
dc.titleRace and Income Association with Health Service Utilization for Veterans with Heart Failureen
dc.typeDissertationen
dc.contributor.departmentDepartment of Nursingen
dc.description.advisorMarion, Lucy N.en
dc.description.degreeDoctor of Philosophy (Ph.D.)-
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