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PubMed2006

Early markers of prolonged hospital stays in older people: a prospective, multicenter study of 908 inpatients in French acute hospitals.

OBJECTIVES: To identify early markers of prolonged hospital stays in older people in acute hospitals. DESIGN: A prospective, multicenter study. SETTING: Nine hospitals in France. PARTICIPANTS: One thousand three hundred six patients aged 75 and older were hospitalized through an emergency department (Sujet Agé Fragile: Evaluation et suivi (SAFEs)--Frail Elderly Subjects: Evaluation and follow-up). MEASUREMENTS: Data used in a logistic regression were obtained through a gerontological evaluation of inpatients, conducted in the first week of hospitalization. The center effect was considered in two models as a random and fixed effect. Two limits were used to define a prolonged hospital stay. The first was fixed at 30 days. The second was adjusted for Diagnosis Related Groups according to the French classification (f-DRG). RESULTS: Nine hundred eight of the 1,306 hospital stays that made up the cohort were analyzed. Two centers (n=298) were excluded because of a large volume of missing f-DRGs. Two-thirds of subjects in the cohort analyzed were women (64%), with a mean age of 84. One hundred thirty-eight stays (15%) lasted more than 30 days; 46 (5%) were prolonged beyond the f-DRG-adjusted limit. No sociodemographic variables seemed to influence the length of stay, regardless of the limit used. For the 30-day limit, only cognitive impairment (odds ratio (OR)=2.2, 95% confidence interval (CI)=1.2-4.0) was identified as a marker for prolongation. f-DRG adjustment revealed other clinical markers. Walking difficulties (OR=2.6, 95% CI=1.2-16.7), fall risk (OR=2.5, 95% CI=1.7-5.3), cognitive impairment (OR=7.1, 95% CI=2.3-49.9), and malnutrition risk (OR=2.5, 95% CI=1.7-19.6) were found to be early markers for prolonged stays, although dependence level and its evolution, estimated using the Katz activity of daily living (ADL) index, were not identified as risk factors. CONCLUSION: When the generally recognized parameters of frailty are taken into account, a set of simple items (walking difficulties, risk of fall, risk of malnutrition, and cognitive impairment) enables a predictive approach to the length of stay of elderly patients hospitalized under emergency circumstances. Katz ADLs were not among the early markers identified.

Accidental Falls↗

PubMed1994

Hospital and police procedure when a patient absconds from a mental hospital.

Despite several studies of absconding from mental hospitals, what the hospitals and the police do following a patient absconding from a mental hospital has been largely ignored. This article fills that gap. It looks at the procedure followed by three conventional mental hospitals in south-east England and the procedure followed by the three Police Forces in those hospitals' catchment areas. It is based on twelve months of fieldwork, during which period the policy files of all the hospitals were studied and, among other things, interviews were carried out with a cross-section of both the hospitals' staff and police officers. The crucial factors determining the type of action taken by the hospitals or the police were found to be whether the matter was one of grave concern and whether the absconder was a compulsory patient. Certain aspects of the procedure were found to be unsatisfactory and suggestions for improving them are made.

Commitment of Persons with Psychiatric Disorders↗

PubMed1995

Hospital stressors experienced by elderly medical inpatients: developing a Hospital Stress Index.

OBJECTIVE: To develop a long and short version of an index to measure experiences during hospitalization perceived by elderly patients as stressful. SAMPLES AND METHODS: Consecutive patients aged sixty or over admitted to a university teaching hospital were assessed for hospital-related stressors during two separate studies. In the first study, seventy-six patients were asked an open-ended question exploring what they found most stressful about being in the hospital. Responses were grouped into major categories, and questions were developed to address concerns in each category; the resulting forty items were called the Hospital Stress Index (HSI). The HSI was then administered to a separate group of ninety-two patients; data were also collected on functional disability (impaired ADLs), dysfunctional attitudes (DAS), and depressive symptoms (CES-D). RESULTS: Spontaneously reported hospital stressors were grouped into seven categories: 1) adverse effects of diagnostic or therapeutic procedures/treatments, 2) forced life-style changes, 3) relationships with staff, 4) individual psychiatric issues, 5) understanding diagnosis/prognosis, 6) family issues, and 7) the physical environment. The largest category of stressors concerned relationships with doctors and nurses. High HSI scores were significantly more common among Whites than Blacks and among patients with high CES-D, high DAS, or impaired ADLs scores. A number of potentially modifiable hospital-related stressors and individual patient issues were identified. Finally, an abbreviated fifteen-item HSI was developed to maximize patient discriminability, highlight individual differences, and enhance the detection of modifiable stressors. CONCLUSIONS: Hospital-reported stressors may contribute to the emotional distress that elderly inpatients experience. We have developed an index to identify such stressors.

Activities of Daily Living↗

PubMed2000

[Hospital acquired pneumonia--analysis of frequency and etiology in Polish hospitals in 1998].

Hospital-acquired pneumonia (HAP) is one of the most frequently occurring hospital infections in the world. This study describes the incidence of HAP in Poland, as well as the specific risk factors leading to this type of infection in Polish hospitals; including those of patient age, length of hospitalization, and use of mechanical ventilation. The epidemiology of HAP as well as treatment resistance of various causal organisms was studied. Data for this study was acquired from the Registry of Hospital-acquired Infectious Diseases for the year 1998. Out of 329,608 hospital-acquired infections in all patients except newborns, 920 were found to be HAP. This study showed that of every 1000 hospital admissions three patients developed HAP (0.3%). Death occurred in 260 of 920 HAP cases or 30%; and HAP found to be the direct cause of death in 66 of the 260 cases (25%). The greatest incidence of HAP was found to occur in patients older than 75 years, was directly related to the length of hospital stay, and was higher in patients on mechanical ventilation longer than 10 days. The most frequently isolated causal agents were the Gram-negative rods (Pseudomonas aeruginosa, Acinetobacter sp., Klebsiella sp., Enterobacter sp.), and Staphylococcus aureus. Streptococcus pneumoniae and Haemophilus influenzae were found in only 2% and 4% of cases, respectively, and thus were the least likely causes of HAP in this population. It was found that the percentage of methicillin-resistant strains of Staphylococcus aureus was very high (55% to 60%); vancomycin-resistant enterococci were only found in patients who did not undergo surgery. The isolated strains of Pseudomonas aeruginosa showed marked resistance to chinolones (58-76%) and to imipen (approximately 20%). In the Enterobacteriaceae family, Klebsiella sp. was found to be resistant to third-generation cephalosporins (56-73%) and Enterobacter sp. resistant in 55% to 81% of the isolates.

Adolescent↗

PubMed1988

Hospital costs, resource characteristics, and the dynamics of death for hospitalized gastroenterology patients.

The federal Medicare diagnosis-related group (DRG) hospital payment system has been on-line for 5 yr with no major adverse effects on either access or quality of care. The hospital industry contends that DRGs are underpaying for hospital care, especially for certain types of patients. Analysis of 2,500 gastroenterology patients by outcome (i.e., survivors vs mortalities) demonstrated that the 122 mortalities had a much greater intensity of hospital resource utilization, and generated substantial financial risk under DRG pricing schemes, compared with the 2,378 survivors. Only mortalities that occurred within 1 wk of admission to the hospital were profitable under DRGs. A long hospital length of stay (LOS) for mortalities was very unprofitable (mortalities with more than a 60-day LOS generated $20,210 loss per patient). Emergency gastroenterology admissions who died had greater financial risk under DRGs, compared to nonemergency mortalities. Those mortalities referred to gastroenterology from other clinical services tended to have greater resource utilization and financial risk under DRGs, compared with nonreferred mortalities. These data suggest significant inequities in the current DRG prospective payment system vis-a-vis gastrotenterology mortalities. Predictive variables of greater hospital resource utilization for gastroenterology mortalities include longer hospital lengths of stay, emergency admission, and referral from another clinical service. If equity of DRG payment is not improved by the federal government, certain groups of patients likely to be mortalities may suffer a decline in access and/or the quality of medical care in the future.

Adult↗

PubMed1993

[Inadequate hospital admissions and inactive days of hospital stay in patients with chronic obstructive pulmonary disease and lung neoplasms].

BACKGROUND: This study was carried out to evaluate the hypothesis that the proportion of inadequate hospital admissions and days is greater in patients with pulmonary neoplasm than in patients with chronic obstructive pulmonary disease (COPD) given the therapeutic and diagnostic features of both diseases and to establish the applicability of the Appropriateness Evaluation Protocol (AEP). METHODS: A retrospective review was performed of the medical records of patients admitted for COPD and pulmonary neoplasm. Two external physicians reviewed the clinical histories using the AEP. Admissions and hospital days considered as potentially inadequate by the reviewers were supervised by a clinical epidemiological panel which confirmed and identified the causes for inadequacy. One hundred sixty-six patients admitted with COPD and 79 with pulmonary neoplasm selected by a systematic sample of admissions whose principal diagnosis was COPD or pulmonary neoplasm were studied over one year in a tertiary level teaching hospital in Barcelona. RESULTS: It was found that 4.8% of the admissions with COPD and 15.5% of the days of hospital stay were inappropriate while in patients with pulmonary neoplasm 14% of the admissions and 40% of the days of hospital stay were inappropriate. The main causes of inadequacy were: social (33.3% in patients with COPD); patients inadequately admitted but who remained in hospital to undergo diagnostic tests which could have been performed on an out patients basis (46% in patients with pulmonary neoplasm). CONCLUSIONS: Inappropriateness was greater in admissions and in hospital days with greater diagnostic components (pulmonary neoplasm) than in fundamentally therapeutic cases (COPD). The Appropriateness Evaluation Protocol was valid in this hospital with the supervising panel being very useful in the judgement of cases not clearly established in the protocol. The level of inadequacy was found to be similar to that of other studies although the results are not directly comparable.

Aged↗

PubMed1994

Assessing Catholic community hospitals versus nonprofit community hospitals, 1989-1992.

Catholic community hospitals are becoming more like nongovernment, not-for-profit community hospitals of a similar bed size located in the same states. After controlling for state, urban-versus-rural location, and bed-size range, a matched set of 303 Catholic community hospitals are compared with nongovernment, not-for-profit community hospitals. This empirical study documents that the average 1992 Catholic hospital is less profitable, with older equipment, and treats more Medicare patients than the average matched community hospital.

Catholicism↗

PubMed1982

The American Hospital Association's National Data Network and hospital data bases.

The growth and increasing complexity of the hospital industry has created an urgent need for hospital data. However, existing data bases have not been used as extensively or as intensively as they could be. This paper describes the major data bases of the American Hospital Association--the Annual Survey of Hospitals, the National Hospital Panel Survey, and the Special Surveys--and then discusses the American Hospital Association National Data Network, a remote-access, computer-time-sharing system that provides on-line entry into the AHA's data bases. The speed, economy, and ease with which Network data can be retrieved and manipulated means that national hospital data can now be disseminated more widely throughout the health care industry and can be regularly used for decision making even at the institutional level.

American Hospital Association↗

PubMed1997

Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service.

OBJECTIVE: This study was conducted to determine the relationship, if any, between nutritional status, length of stay (LOS) in hospital, discharge placement, readmission rates, and hospital costs and charges in patients hospitalized in the medicine service. DESIGN: Data regarding medical diagnosis, LOS, hospital costs, charges, discharge destination, and readmission rates were collected prospectively from medical records and through patient interviews on patients admitted to the medical service who were classified to be at risk or not at risk for malnutrition on the basis of established criteria (weight for height < 75% ideal body weight, admission serum albumin level < 30 g/L, or > or = 10% unintentional weight loss within 1 month before admission). SUBJECTS: All patients admitted directly to any of three medicine units during December 1994 who met study criteria were included in the study. Off-service patients, transfer patients, and patients discharged before screening (usually admitted and discharged within 72 hours) were excluded. Data were collected on 173 patients. STATISTICAL ANALYSIS PERFORMED: At-risk and not at-risk patients were compared for LOS, costs and reimbursement, and discharge placement (to home, to home with home health care services, or to another facility for further care). Two sample t tests and alpha survival analysis technique were used to compare continuous variables between the two study cohorts. Nonparametric tests were used for LOS and readmission data. chi 2 Tests were used for categoric variables. An alpha level of .05 was used throughout to determine statistical significance. RESULTS: Median LOS in the not-at-risk population (n = 56) was significantly greater than in the not-at-risk population (n = 117): 6 days (25th percentile = 4 days, 75th percentile = 8 days) vs 4 days (25th percentile = 3 days, 75th percentile = 7 days) (P < .01). Mean hospitalization cost per patient was also higher in the at-risk group ($6,196 vs $4,563, P < .02). Readmission rate per month of follow-up was not significantly different. At-risk patients were significantly less likely to be discharged home with self-care (23[41%] vs 77 [66%], P < .05). At-risk patients were significantly more likely to use home health care service than not-at-risk patients (17[31%] vs 14 or [12%], P < .001). APPLICATIONS: Patients at risk for malnutrition had significantly higher LOS, costs, and home health care needs, despite the fact that 51, or 91%, received nutrition intervention while hospitalized. Further research should explore the use of nutrition screening and intervention before, during, and after hospitalization to ensure that appropriate nutrition intervention, as indicated by medical patients' clinical condition and nutritional risk status, is initiated and continued.

Cohort Studies↗

PubMed1981

Hospitalization of adolescents in a new Children's Hospital.

The amalgamation of two provincial pediatric referral centers into a single new Children's Hospital is examined from the perspective of the pattern of adolescent hospitalization in each. Ministry of Health hospital records for 11-19-year-olds discharged from the two pediatric referral centers during the period 1971-1978 were studied. Patients were divided into five arbitrary groups, based on their length of stay and discharge diagnosis. Level A patients accounted for 43.9% of discharges and were short-stay, uncomplicated, and primarily surgical cases. Level D patients were a much smaller group (16.3%) but accounted for 56.9% of bed days. Violence and pregnancy accounted for 37.8% of all discharges and were the most frequent reason for hospitalization. The present pattern of bed utilization by 11-19-year-olds admitted to these two centers requires an estimated 100 hospital beds per day. If this pattern were to be transposed, unmodified, to the new Children's Hospital, adolescents would use 50% of its 200-bed complement. Planning options to modify this requirement and the impact of changing patterns of hospital utilization are presented.

Adolescent↗

PubMed2006

[Public access to information about the services and quality of care in public hospitals: the need for methodologic clarity. A survey of 44 university hospital directors and administrators].

INTRODUCTION: For the past eight years, the Ministry of Health has released information about the services and quality of care in public hospitals, in response to the increasing concern about hospital performance expressed by patient associations. The press publishes hospital ratings based on this information. This survey asked hospital administrators about their views of communication on this topic. METHODS: This survey, conducted from 7 October through 20 November 2004, sent a two-page open questionnaire to a variety of hospital executive personnel - medical directors, chief administrators, medical school deans, and public information officers - to determine their views on this subject. RESULTS: The response rate was 34%. Without contesting either the legitimacy of the expectation for information or the transparency owed to patients, health professionals expressed the need to know in advance the "rules of the game" and the methodology of the rating techniques to be used. Most reported few changes in their professional behavior due to these publications, the methodology and criteria of which they contested. They suggested changes including different criteria and indicators for the rating, the ability to contest the conclusions drawn from the PMSI data, and the need for preliminary work to define criteria by working groups composed of physicians, other professionals, and even those outside the health field. On the other hand, only half were willing to participate in such a working group. CONCLUSION: These hospital managers see a need for specialists in the analysis of hospital data, who can clarify the meaning of the statistics and improve the public's understanding of them, now shaped by the mass media's failure to provide meaningful analysis.

Health Care Surveys↗

PubMedDate not supplied

Hospital costs of nosocomial infections: a prospective three-month study in a community hospital.

A prospective three-month study of the hospital costs associated with nosocomial infections was done in a 390-bed, 30-bassinet community-teaching hospital early in 1978. All hospital charges for diagnostic and therapeutic services required by nosocomial infections, and added length of stay due to the infections, were recorded. During the study period 123 infections occurred in 104 patients (a 2.7% incidence, considering the 4,485 patients discharged during this time). The average length of stay was prolonged 3.0 days for all nosocomial infections; this accounted for about half of the $636 average hospital charges for each nosocomial infection. The 65 nosocomial urinary tract infections prolonged the length of stay an average of 0.6 days and the total hospital charges were $146 for each infection, leading us to believe that the proportion of nosocomial infections at any given site may greatly alter the "average" cost of nosocomial infections. Our data from a community hospital show a shorter prolongation of length of stay and lower hospital costs when compared with the few other studies in the literature.

Costs and Cost Analysis↗

PubMed2002

Ten-year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis.

AIM: To describe the 10-year prognosis for patients discharged after hospitalization for chest pain or other symptoms giving an initial suspicion of acute myocardial infarction (AMI) in relation to the final hospital diagnosis and furthermore to compare the outcome amongst these patients with the outcome amongst a sex-, age- and community-matched control population. METHODS: All patients who were hospitalized because of chest pain or other symptoms raising a suspicion of AMI and who were discharged alive from hospital. Patients were divided into three groups according to the final diagnosis: (1) confirmed or possible AMI, (2) confirmed or possible myocardial ischaemia and (3) other aetiology. Information on 10-year mortality was available in 3103 patients. A sex-, age- and community-matched control population (n=3221) was compared with the study population in terms of 10-year mortality. TIME OF SURVEY: 15 February 1986 to 9 November 1987. SETTING: Sahlgrenska University Hospital. RESULTS: Patients with confirmed or possible AMI (n=849) had a significantly higher mortality (59.4%) than patients with confirmed or possible myocardial ischaemia (n=1191) who had a mortality of 49.5% (P < 0.0001). The latter group had a higher mortality than patients with 'other aetiology' (n=1063) of whom 40.6% died (P < 0.0001). When comparing the prognosis for patients with AMI and myocardial ischaemia, there was a significant interaction with sex, with a more marked difference in women than in men. Amongst all patients, the 10-year mortality was 49.1 vs. 37.3% in the control group (P < 0.0001). CONCLUSION: The very long term prognosis was strongly associated with diagnosis amongst patients hospitalized and discharged alive because of chest pain or other symptoms raising suspicion of AMI. The absolute mortality difference between patients who were discharged from hospital with confirmed diagnosis of AMI and those whose symptoms were considered to have other aetiology than AMI or ischaemia was nearly 20%. However, the absolute mortality difference between the patients included in the survey and a control population was only 12%.

Aged↗

PubMed2002

Satisfaction with hysterectomy: low-income underinsured teaching hospital patients versus insured patients at a private hospital.

OBJECTIVE: The purpose of this study was to measure patient health-related quality of life/satisfaction with the results of hysterectomy in 2 distinct groups of women. STUDY DESIGN: A health-related outcomes questionnaire was completed 3 months after hysterectomy by 50 low-income women who underwent operation at a state-supported teaching hospital and by 50 women who underwent operation at a private hospital. RESULTS: The women at the teaching hospital had a significantly worse outcome satisfaction score than the women at a private hospital. However, 98% of the patients at the teaching hospital and 100% of patients at the private hospital noted their symptoms to be improved. Factors such as race, age, preoperative indications, route of hysterectomy, oophorectomy, and hormone replacement therapy did not affect outcome scores. CONCLUSION: Low-income women who undergo operation at a university teaching hospital experience lower satisfaction after hysterectomy than do other women.

Adult↗

PubMed1998

Antimicrobial use and resistance in eight US hospitals: complexities of analysis and modeling. Intensive Care Antimicrobial Resistance Epidemiology Project and National Nosocomial Infections Surveillance System Hospitals.

OBJECTIVE: To evaluate the relation between antimicrobial use and resistance in intensive-care unit (ICU) and non-ICU inpatient areas in eight US hospitals. METHODS: We determined antimicrobial use in terms of defined daily doses, antimicrobial-use density (defined daily doses/1,000 patient days), and percentage resistance for five antimicrobial-organism combinations in the ICU and non-ICU inpatient areas of eight US hospitals participating in project Intensive Care Antimicrobial Resistance Epidemiology. RESULTS: Antimicrobial resistance and use varied tremendously among the eight hospitals. Antimicrobial resistance among these five nosocomial pathogens was significantly higher within the inpatient setting of these hospitals, compared with the outpatient setting. One hospital consistently ranked highest for use of all classes of antimicrobials examined. High antimicrobial use was not associated necessarily with high resistance for a particular antimicrobial-organism pair. CONCLUSION: Antimicrobial use varied significantly across these hospitals, but generally was higher in ICUs. These results suggest that concomitant surveillance of both antimicrobial resistance and antimicrobial use is helpful in interpreting antimicrobial resistance in a hospital or ICU and that further analysis is required to determine the role of variables other than antimicrobial use in a statistical model for predicting antimicrobial resistance.

Anti-Bacterial Agents↗

PubMed2004

Evaluation of the participation of Aretaieion Hospital, Greece in the WHO Pilot Project of Health Promoting Hospitals.

Aretaieion University Hospital participated in the World Health Organization (WHO) Pilot Health Promoting Hospitals Project from 1993 until 1997, when the Hellenic Network of Health Promoting Hospitals was established. This study is an overall evaluation of the participation of Aretaieion Hospital at the HPH Pilot Project. The evaluation comprised two questionnaire surveys, one among all the professionals, and the other among the patients involved in the subprojects. At the professional's survey, the response was 88.6% (39), while at the patient's survey the response was 62.2% (84). Differences were identified between the perceptions of the professionals who were external collaborators and those who were members of the hospital staff. Problems of the Project were reported to be lack of funding, lack of time and personnel shortages, lack of health promotion background and lack of incentives. Major successes were reported to be the personnel training, the development of collaboration and teamwork, the improvement of the overall image of the hospital into the community, the improvement of the working conditions of the personnel. Perception of sustainability of the projects by health professionals was found to be related to how interesting they found their subproject and how relevant to the work of their department. The communication strategy was inadequately planned and this resulted in some difficulties in developing rapport with the patients. However, the patients felt that they benefited from the project, a view also held by the hospital staff professionals.

Attitude of Health Personnel↗

PubMed2003

Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals.

OBJECTIVE: To study the adherence to local hospital guidelines for antimicrobial prophylaxis in surgery, and explore reasons for non-adherence. METHODS: A prospective, multicentre audit of elective procedures, without prior suspicion of infection, was carried out in 13 Dutch hospitals. By reviewing medical, anaesthetic and nursing records, and medication charts, the prescription of antibiotics was compared with the local hospital guideline on antibiotic choice, duration of prophylaxis, dose, dosing interval and timing of the first dose. RESULTS: Between January 2000 and January 2001, 1763 procedures were studied. Antibiotic choice, duration, dose, dosing interval and timing of the first dose were concordant with the hospital guideline in 92%, 82%, 89%, 43% and 50%, respectively. Overall adherence to all aspects of the guideline, however, was achieved in only 28%. The most important barriers to local guideline adherence were lack of awareness due to ineffective distribution of the most recent version of the guidelines, lack of agreement by surgeons with the local hospital guidelines, and environmental factors, such as organizational constraints in the surgical suite and in the ward. CONCLUSION: This study shows that, although adherence to separate aspects of local hospital guidelines for surgical prophylaxis in the Netherlands is favourable, overall adherence to all parameters is hard to achieve. Adherence to guidelines on dosing interval and timing needs improvement, in particular. To increase the quality of antimicrobial prophylaxis in surgery, effort should be put into developing guidelines acceptable to surgeons, in adequately distributing the guidelines and to facilitating logistics. Audits of surgical prophylaxis may help hospitals identify barriers to guideline adherence.

Adult↗

PubMed1992

Studying outcomes and hospital utilization in the elderly. The advantages of a merged data base for Medicare and Veterans Affairs hospitals.

That veterans aged 65 years and older are eligible to receive care either in the Veteran Affairs (VA) health care system or in the private sector under Medicare confounds the analysis of veterans' health services utilization and outcomes in two ways. First, changes in eligibility or financial barriers to access with regard to either system influence veterans' decisions about where to seek needed care. Second, analyses of VA care for elderly veterans that rely solely on VA data sources underestimate both overall utilization and treatment complications. Similarly, failure to consider the contribution of health care delivery in the VA system may confound analyses of health care utilization by the Medicare-eligible population. To study the magnitude of such confounding influences, we linked the Medicare and VA health care administrative databases for residents of New England and New York. Results indicated that, for ten surgical procedures commonly performed in the elderly, as well as for hospitalizations resulting from acute myocardial infarction and hip fracture, VA patients receive from 17.6% to 37.4% of hospital care outside the VA system. Private hospitalizations account for 5.5% to 19.5% of the care received by veterans within 6 months after an initial episode of care in a VA hospital. It was also found that initial hospitalizations for study conditions in the VA accounted for 3.6% of all such hospitalizations among elderly Medicare-eligible men. Although overall hospital utilization appears to be underestimated in VA data sources, it was found that ascertaining mortality from sources available within the VA produced excellent results when compared with deaths recorded in the Medicare enrollment files. A national, merged VA-Medicare data base is feasible and would enhance the validity of analyses of health care delivery both for elderly veterans and for the Medicare population.

Aged↗