Preventable Hospitalization in Older Military Retirees

Tricare Senior Prime (TSP) is the government's attempt to restore promised health care benefits to the nation's older military retirees. Under the TSP demonstration project, participating Military Treatment Facilities must function as Medicare Health Maintenance Organizations and provide all but a very few services to enrolled military beneficiaries > 65 years of age. This mission places new, and as yet unquantified demands upon the Military Healthcare System. Potentially preventable hospitalizations are hospital admissions for a group of conditions that could potentially have been treated in the ambulatory care setting. This study will use a two-part panel design to prospectively assess the relationship between patient-specific characteristics and the likelihood of potentially preventable hospitalization for TSP enrollees. Andersen's (1995) Behavioral Model of Health Services Use provides the conceptual framework for the study and guided the selection of patient risk factors. All 3,300 Madigan Army Medical Center TSP enrollees will be surveyed to obtain baseline predisposing (age, gender, race, education, education, living arrangements), enabling (income, tangible social support, perceptions of regular source of care, transportation, transportation time) and need factor (perceived physical health status, perceived mental health status, perceived functional limitations, chronic illnesses, past hospital use) data. These data will subsequently be linked to hospitalization data prospectively collected for the 12-month period following the survey. Each study participant's hospital use will be classified into one of three categories: 1) no hospital admissions, 2) at least one potentially preventable hospitalization, or 3) hospitalized, but not for a potentially preventable condition. Analysis: Descriptive statistics will be used to profile the sample in terms of the factors under study and summarize the frequency of occurrence of each type of hospital use. Logistic regression will be used to identify predisposing, enabling and need factors associated with the likelihood of potentially preventable hospitalization. Little is known about the health care utilization patterns of Medicare-eligible military retirees. This study represents an important beginning in the quest to understand the health care needs of older military retirees and their family members. Knowledge gained from this study will provide military nurses and other health care planners with a better understanding of the factors associated with increased risks of potentially preventable hospitalization. Targeted programs can then be instituted to help vulnerable senior populations better manage acute and chronic episodes of illness and avoid hospitalization. Reducing the rate of preventable hospitalizations will not only decrease health care costs, but also more importantly, improve the quality of patients' lives and those of their families.