Healthcare use by veterans treated for diabetes mellitus in the Veterans Affairs medical care system

Objectives: To estimate the burden of comorbid conditions and to describe patterns of inpatient and outpatient service use by veterans with diabetes mellitus. Study Design: Retrospective cohort study of 33 481 veterans conducted by means of secondary analysis of Department of Veterans Affairs (VA) healthcare utilization databases. Patients and Methods: The cohort was constructed enrolling,all veterans treated in the VA medical care syste who had their initial VA hospitalization for diabetes mellitus between 1992 and 1997. To estimate the typical annual pattern of service use for diabetes mellitus, 1497 utilization rates per person-year were analyzed based on cohort members surviving into 1997. Data on comorbid conditions were obtained from outpatient and inpatient contacts. Results: The 3 most prevalent coexisting conditions were hypertension (73.4%), ischemic heart disease (35.2%), and alcohol or drug abuse disorders (29.5%). In 1997, the typical cohort member followed for 12 months had 6 primary care visits, 16 other visits for tests or consultations, and 1.3 unscheduled visits for emergency- or urgent care and spent approximately 8 days in the hospital. One-year survival was 94.0%. Conclusions: In the VA medical care system, beneficiaries with diabetes mellitus have an extremely heavy burden of comorbidities, face a significant risk of dying in a given year (approximately 6% in this population), and are heavy users of hospital and outpatient services.