Date of Award

6-2011

Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Laura L, Hayman

Second Advisor

Amy K. Rosen

Third Advisor

Eileen Stuart-Shor

Abstract

Context: Health care utilization and outcomes have been linked to multiple factors both clinical and non-clinical, including distance to care.

Purpose: The purpose of this study was to test the association between distance to care and readmission for reintervention in the year following lower extremity arterial bypass in the Veterans Health Administration (VA).

Methods: VA databases were used in this study of patients who underwent lower extremity arterial bypass from 2003 to 2006. Health care utilization was identified over the follow-up year. Readmission was regressed on distance to care using multivariate logistic regression models.

Results: Out of 5,555 patients discharged following lower extremity bypass surgery, 23.3% were readmitted for reintervention within one year of surgery. Patients were almost exclusively male (99.1%), White (76.8%), with a mean age of 65.2 ± 9.8 years. Approximately 18.6% were Black and 4.6% were combined in a non-Black/non-White grouping. The majority, 62%, lived within 50 miles of the surgical center. Distance to care was not found to be significantly associated with readmission for reintervention after controlling for demographic factors, region, severity of illness, comorbidities, and outpatient vascular use. Significant factors for readmission in the fully adjusted logistic regression model included increasing age (OR=.99, p = .003), Black race (OR=1.2, p=.03) Midwest region (OR=.8, p =.01), intermittent claudication (OR = .8, p=.002), critical limb ischemia (OR =1.4, p <.0001), diabetes (OR = 1.3, p<.0001) and low outpatient vascular use (OR = .7, p <.0001).

Conclusion: As patients' distance to care increased, they were not more likely to be readmitted for secondary procedures. Quality initiatives to improve access could be in part responsible; however, the effect of private sector utilization might also have affected the results. Recommendations for future research include expanding the study to obtain additional comorbidities and a prospective study designed to include clinical factors (medications, vascular testing, and additional comorbidities), health care utilization, and quality of life over the follow-up year.

Comments

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