Echocardiogram Utilization Among Rural and Urban Veterans

Authors

  • Kingston Okrah MD, MS,

    1. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Administration Medical Center, Iowa City, Iowa
    3. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    Search for more papers by this author
  • Mary Vaughan-Sarrazin PhD,

    1. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Administration Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    Search for more papers by this author
  • Peter Kaboli MD, MS,

    1. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Administration Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    3. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VAMC, Iowa City, Iowa
    Search for more papers by this author
  • Peter Cram MD, MBA

    1. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Administration Medical Center, Iowa City, Iowa
    2. Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
    Search for more papers by this author

  • Dr. Okrah received fellowship stipend and tuition support from the Cardiovascular Interdisciplinary Research Training Grant, Iowa Cardiovascular Center, University of Iowa Carver College of Medicine. Dr. Cram has an appointment in the Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Medical Center, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. Dr. Cram is supported by a K23 career development award (RR01997201) from the NCRR at the NIH and the Robert Wood Johnson Physician Faculty Scholars Program. Dr. Kaboli has an appointment in the VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region at the Iowa City VA Medical Center, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health. For further information contact: Kingston Okrah, MD, MS, Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Mailstop 152, Iowa City VAMC, Iowa City, IA 52246; e-mail: kingston-okrah@uiowa.edu.

Abstract

Purpose: To compare echocardiography use among urban and rural veterans and whether differences could be accounted for by distance.

Methods: We used Veterans Administration (VA) administrative data from 1999 to 2007 to identify regular users of the VA Healthcare System (VA users) who did and did not receive echocardiography. Each veteran was categorized as residing in urban, rural or highly rural areas using RUCA codes. Poisson regression was used to compare echocardiography utilization rates among veterans residing in each area after adjusting for demographics, comorbidities, clustering of patients within VA networks and distance to the nearest VA medical center offering echocardiography.

Findings: Our study included 22.7 million veterans of whom 1.3 million (5.7%) received at least 1 echocardiogram. Of echocardiography recipients, 69.2% lived in urban, 22.0% in rural and 8.8% in highly rural areas. In analyses adjusting for patient demographics, comorbidities, and clustering, utilization of echocardiography was modestly lower for highly rural and rural veterans compared with urban veterans (42.0 vs 40.1 vs 43.1 echocardiograms per 1,000 VA users per year for highly rural, rural and urban, respectively; P < .001). After further adjusting for distance, echocardiography utilization was somewhat higher for veterans in highly rural and rural areas than it was for urban areas (44.9 vs 41.8 vs 40.8 for highly rural, rural and urban, respectively; P < .001).

Conclusions: Echocardiography utilization among rural and highly rural veterans was marginally lower than for urban veterans, but these differences can be accounted for by the greater distance of more rural veterans from facilities offering echocardiograms.

Ancillary