Evidence map›Paper›PMID 38977515›Full record

ArticleJournal of general internal medicine2024

Use and Cost of Low-Value Services Among Veterans Dually Enrolled in VA and Medicare.

Thomas R Radomski, Elijah Z Lovelace, Florentina E Sileanu, Xinhua Zhao, Liam Rose, Aaron L Schwartz, Loren J Schleiden, Aimee N Pickering, Walid F Gellad, Michael J Fine and 1 more

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The definition of atypical femoral fractures should include periprosthetic femoral fractures (PAFFs).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Thomas R RadomskiCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. radomskitr@upmc.edu.ORCID 0000-0002-7279-188X
Elijah Z LovelaceCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Florentina E SileanuCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Xinhua ZhaoCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Liam RoseHealth Economics Resource Center (HERC), VA Palo Alto Healthcare System, Palo Alto, CA, USA.
Aaron L SchwartzCenter for Health Equity Research and Promotion (CHERP), Crescenz VA Medical Center, Philadelphia, PA, USA.
Loren J SchleidenCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Aimee N PickeringCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Walid F GelladCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Michael J FineCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Carolyn T ThorpeCenter for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.

Funding

Use and costs of low-value health services by Veterans in VA and non-VA settingsI01HX003039 · VA · VETERANS HEALTH ADMINISTRATION · PI THORPE, CAROLYN TIMBERLAKE · 2020 to 2024
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Understanding Low-Value Veteran Care with Natural ExperimentsIK2HX003634 · VA · PHILADELPHIA VA MEDICAL CENTER · PI Aaron Lawrence Schwartz · 2024 to 2026
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HSRD VA I01 HX003039HSRD VA IK2 HX003634U.S. Department of Veterans Affairs 5I01HX003039
6 · The paper itself

Abstract

backgroundOver half of veterans enrolled in the Veterans Health Administration (VA) are also enrolled in Medicare, potentially increasing their opportunity to receive low-value health services within and outside VA.

objectivesTo characterize the use and cost of low-value services delivered to dually enrolled veterans from VA and Medicare.

designRetrospective cross-sectional.

participantsVeterans enrolled in VA and fee-for-service Medicare (FY 2017-2018). MAIN MEASURES: We used VA and Medicare administrative data to identify 29 low-value services across 6 established domains: cancer screening, diagnostic/preventive testing, preoperative testing, imaging, cardiovascular testing, and surgery. We determined the count of low-value services per 100 veterans delivered in VA and Medicare in FY 2018 overall, by domain, and by individual service. We applied standardized estimates to determine each service's cost. KEY

resultsAmong 1.6 million dually enrolled veterans, the mean age was 73, 97% were men, and 77% were non-Hispanic White. Overall, 63.2 low-value services per 100 veterans were delivered, affecting 32% of veterans; 22.9 services per 100 veterans were delivered in VA and 40.3 services per 100 veterans were delivered in Medicare. The total cost was $226.3 million (M), of which $62.6 M was spent in VA and $163.7 M in Medicare. The most common low-value service was prostate-specific antigen testing at 17.3 per 100 veterans (VA 55.9%, Medicare 44.1%). The costliest low-value service was percutaneous coronary intervention (VA $10.1 M, Medicare $32.8 M).

conclusionsNearly 1 in 3 dually enrolled veterans received a low-value service in FY18, with twice as many low-value services delivered in Medicare vs VA. Interventions to reduce low-value services for veterans should consider their substantial use of such services in Medicare.

Indexed as

MedicareUnited States Department of Veterans AffairsVeteransAgedAged, 80 and overCross-Sectional StudiesFemaleHealth Care CostsHumansMaleRetrospective StudiesUnited StatesVeterans Health Serviceslow-value carequality of careveterans

Identifiers

PMID38977515
PMCPMC11347549

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.