# Presentation: 377705

## Utilization of Veterans AffairsMedical Care Services by United States Veterans

**Notes:**
This slide kit describes the prevalence of chronic conditions and presents selected healthcare utilization measures among Veterans Affairs (VA) medical care system users from fiscal year 1997 through the first half of fiscal year 2001.

## Data Sources

- Data sources
- Veterans Affairs (VA) Patient Treatment File (PTF) – discharge data for every hospital stay
- VA Outpatient Clinic File (OPC) – ambulatory contacts
- Time period FY1997 – first half FY2001(10/1/96–3/30/01)

**Notes:**
Individuals included in this analysis are United States Veterans who used Veterans Affairs (VA) acute care facilities or made at least one outpatient visit to a VA staff member from October 1, 1996, through March 30, 2001 (fiscal year 1997 through the first half of fiscal year 2001). These veterans are referred to as “system users” throughout this presentation.  Excluded are active duty military, VA employees, and other non-veterans who would not use the VA system as a regular source of care. Also excluded are individuals who used other care provided by or paid for by the VA such as long-term care.

The VA Patient Treatment File (PTF) has been maintained electronically since the mid-1970s and contains records of all VA hospital stays, including demographic and discharge information for each episode of care.  The file is maintained by the VA at the Austin, TX Automation Center.

The VA Outpatient Clinic File (OPC) has been maintained electronically since 1980 and contains records of all outpatient visits by veterans to Veterans Affairs Staff.  The file is maintained by the VA at the Austin, TX Automation Center.

## Selected Demographic Characteristics Among VA System UsersFY1997 – First Half FY2001

**Notes:**
5.2 million US veterans, 20% of all US veterans, used an acute care hospital and/or outpatient clinic of the VA medical system between FY1997 through the first half of FY2001.

On the slides that follow, demographic information is presented for users of the VA medical care system.

## Veterans Affairs Medical Care System Users

**Veterans Affairs Medical Care System Users**

- 1997

- 4

**System Users (millions)**

- 1998

- 1999

- 2000

- 2001

- 3

- 2

- 1

- 0

**Fiscal Year**

**Notes:**
This slide shows the number of US veterans who sought VA medical care yearly from FY1997 through FY2001.

The number of system users has increased year over year, from 2.7 million in FY1997 to 3.7 million in FY2001, a 40% increase.

The number of unique VA medical care system users from FY1997 through the first half of FY2001 was approximately 5.2 million, although not all users sought care during the same year.

Overall, these veterans represent a low-income group: the median income is $15,000.

Note that this analysis includes users from FY1997 through the first half of FY2001.

## Selected Demographic Characteristics Among VA System Users

- Predominantly male (96%)
- Mean age 60 years; 54% users aged less than 65
- Mean age of men, 61; mean age of women, 47
- Race* – White (75%), Black (18%),             Other (7%)
- Median income $15K
- Marital status
- Married	54.7%
- Not married 	39.8%
- Unknown 	5.6%

- * Race was not known for 42% of VA system users

**Notes:**
Most of the 5.2 million veterans who used VA medical care from FY1997 through the first half of FY2001 are men.

54% of VA system users are younger than 65.

Female system users are considerably younger than their male counterparts, with a mean age of 47 compared with 61 among male users.

75% of Veterans seeking care are Non-Hispanic White,  18% are Black, and 7% are classified as Other: Hispanic White, Hispanic Black, Asian, or Native American. Note that race information was not known for 42% of VA system users.

The majority of VA medical care system users are married (55%).

Those defined as not married (approximately 40%) include veterans who are single, never married, divorced, separated, or widowed.

## Age of Veterans AffairsMedical Care System Users

**Percent of Total Population**

- <25

- 30

- 25

- 15

- 10

- 0

**Age of Veterans Affairs****Medical Care System Users**

- 25–34

- 35–44

- 45–54

- 65–74

- 75–84

- 85

- From FY1997 through first half FY2001

- 5

- 20

- 55–64

**Age**

**Notes:**
More than half of all veterans who sought care between FY1997 and the first half of FY2001 (54%) were younger than 65 years.

21% of system users are aged 45 to 54, reflecting Vietnam War era veterans, and 44% of system users are aged 65 to 74 and 75 to 84, reflecting the Korean Conflict and World War II era veterans, respectively.

The overall mean age of a VA medical care system user is 60 years.

## Age of Veterans AffairsMedical Care System Users by Gender

**Age of Veterans Affairs****Medical Care System Users by Gender**

- 0

- 10

- 20

- 30

- 40

- 40

- 30

- 20

- 10

- 0

**Percent of Women in Each Age Group**

**Percent  of Men in Each Age Group**

- <25

- 25–34

- 35–44

- 45–54

- 65–74

- 75–84

- 85

**Age Group**

- From FY1997 through first half FY2001

- 55–64

**Notes:**

Women veterans who use the VA are considerably younger than their male counterparts.

6% of all female system users are less than 25 years old compared with only 1% of male system users.

27% of women utilizing VA medical care are aged 35-44; only 10% of male care seekers are aged 35-44.

The average age of a female system user is 47 years; male system users have an average age of 61 years.

## The Prevalence of Chronic Conditions Among VA Medical CareSystem Users

**The Prevalence of ****Chronic Conditions ****Among VA Medical Care****System Users**

**Notes:**
The prevalence of chronic conditions was assessed among veterans who used the Veterans Affairs (VA) acute care facilities or made at least one outpatient visit to a VA staff member from FY1997 through the first half of FY2001.

The term prevalence is used in this analysis to denote the proportion of all system users who have been diagnosed as having a particular chronic condition during the time period FY1997 through the first half of FY2001.

ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes from the veterans’ medical records were used for diagnostic classification of disease.   

Note: The Appendix slides list the ICD-9-CM codes for the chronic conditions discussed in this presentation.

## Prevalence of Chronic Conditions AmongVeterans Affairs Medical Care System Users by Gender: Cardiovascular Disease

**Percent of System Users With Condition**

- 0

- 10

- 20

- 30

- 40

- 50

- Hypertension

- Ischemic Heart Disease

- Hyperlipidemia

- Cardiac Dysrhythmia

- Congestive Heart Failure

- Men
- Women
- Total

**Prevalence of Chronic Conditions Among****Veterans Affairs Medical Care System Users by Gender: Cardiovascular Disease**

- From FY1997 through first half FY2001

**Notes:**
Cardiovascular disease prevalence increases with age.  Female system users are younger, on average (mean age 47), than male system users (mean age 61).  Consequently, prevalence of cardiovascular conditions is lower among women.

Because women make up only 4% of total users, their effect on overall prevalence of any one condition is minimal.

Hypertension was the most prevalent chronic condition among VA system users, affecting 46% of this population.  The prevalence of hypertension among female system users is 27%.

23% of total VA system users have ischemic heart disease, the third most prevalent chronic condition in this population.  

The prevalence of hyperlipidemia is 21% among male system users and 13% among women system users. 

Men were about twice as likely to be affected by cardiac dysrhythmia (10%) as women (6%), and congestive heart failure also affects about twice as many men ( 8%) as women (3%).

## Prevalence of Chronic Conditions AmongVeterans Affairs Medical Care System Users by Gender: Other Chronic Conditions

**Percent of System Users With Condition**

- 0

- 10

- 20

- 30

- 40

- Diabetes

- Chronic Obstructive Pulmonary Disease

- Men
- Women
- Total

- Pneumonia

- Cerebrovascular Disease

- Peripheral Arterial Disease

- Arthropathies

- Cancer

- Epilepsy

- HIV *

**Prevalence of Chronic Conditions Among****Veterans Affairs Medical Care System Users by Gender: Other Chronic Conditions**

- From FY1997 through first half FY2001

*****Human Immunodeficiency Virus

**Notes:**
At 35%, arthropathies (including osteoarthritis, rheumatoid arthritis, and related conditions) rank as the second most prevalent of all chronic conditions (after hypertension, 46%).

Female system users have slightly higher prevalence of arthropathies than men, 38% vs. 34%.

Diabetes and chronic obstructive pulmonary disease (COPD) are also prevalent chronic conditions among system users, at 18% and 19%, respectively, with female users experiencing 9% and 17% prevalence, respectively.

Female system users are half as likely as male users to have diabetes (9% vs. 19%), pneumonia (2% vs. 4%), cerebrovascular disease (4% vs. 9%), and peripheral arterial disease (3% vs. 8%).

## Prevalence of Chronic Conditions AmongVeterans Affairs Medical Care System Users by Gender: Mental Disorders and Alzheimer’s Disease

**Prevalence of Chronic Conditions Among****Veterans Affairs Medical Care System Users by Gender: Mental Disorders and Alzheimer’s Disease**

- From FY1997 through first half FY2001

- 0

- 5

- 10

- 15

- 20

- 25

**Percent of System Users With Condition**

- Alcohol and Drug Dependence

- Senile, Pre-senile Organic, Other Psychotic Conditions*

- Alzheimer’s Disease

- Schizophrenia

- Depression

- *Excludes Schizophrenia

**Notes:**
The prevalence of mental disorders is 37% overall. Among male system users, it is 37%; and among female users, 40%. 

The average age of a system user with any diagnosed mental disorder is 58. Among those with a mental disorder, 12% are 35 to 44 years old, 19% are 65 to 74, and 29%, the highest proportion, are 45 to 54. 

Overall, the prevalence of senile, pre-senile organic, and other psychotic conditions, excluding schizophrenia, is 13%, with more women (19%) affected than men (13%).  Examples of these mental disorders include uncomplicated senile dementia, affective psychoses, and paranoid states.

The prevalence of depression is higher among female system users than among male system users, 20% vs. 12%.

10% of male veterans using VA medical care have alcohol and drug dependence compared with 6% of women system users.

Schizophrenia has a 4% prevalence rate among VA system users.

Alzheimer’s diseases affects 1% of the population of VA system users.

## Rank Ordered Prevalence of ChronicConditions Among Male and Female VASystem Users

- 1	Arthropathies (38%)	Hypertension (46%)
- 2	Hypertension (27%)	Arthropathies (34%)
- 3	Depression (20%)	Ischemic heart disease (24%)
- 4	Senile, pre-senile organic,  	Hyperlipidemia (21%) 	other psychotic conditions (19%)
- 5	Chronic obstructive	 Chronic obstructive 	pulmonary disease (17%)	 pulmonary disease (19%);		Diabetes (19%)

- Orange – Psychiatric; Purple – Medical
- From FY1997 through first half FY2001

**Rank Ordered Prevalence of Chronic****Conditions Among Male and Female VA****System Users**

**Female (% prevalence)**

**Notes:**
While hypertension, arthropathies, ischemic heart disease, and hyperlipidemia rank as the most prevalent conditions among the overall population of veterans seeking VA medical care (a population comprised primarily of men), a slightly different pattern emerges when examining chronic disease among women system users.

Arthropathies and hypertension rank first and second among women VA system users, while the ranking is reversed among male veterans using VA care.

Senile, pre-senile organic, and other psychotic conditions (excludes schizophrenia), and depression are among the top 5 conditions among female veterans utilizing VA medical services but are not among the top conditions for male system users. 

Both women and men system users have a high prevalence of chronic obstructive pulmonary disease

## Healthcare ResourceUtilization  Inpatient and Outpatient Measures

**Healthcare Resource****Utilization **** ****Inpatient and Outpatient Measures**

**Notes:**
On the following slides, healthcare resource utilization is assessed among veterans who used VA acute care facilities or had an outpatient clinic visit during the time period FY1997 through the first half of FY2001. 

VA healthcare resource utilization includes hospital discharge diagnoses and measures of inpatient utilization (length of stay) and outpatient system use (principal medicine visits and psychiatric visits).

Inpatient measures reflect the time period FY1997 through the first half of FY2001. 

Because the average number of outpatient visits per user remained stable from year to year, selected outpatient measures from FY2000 are shown, representing the most recent full year of available data.

## Rank Ordered Hospital Discharges Among VA System Users by Age

- 1	Psychoses	Psychoses	Alcohol/drug	  Alcohol/drug 	 Alcohol/drug	 Chronic	 Heart failure	 Simple 				dependence	dependence	dependence	 obstructive	 and shock 	 pneumonia 						pulmonary		 and pleurisy 							 disease
- 2	Alcohol/drug	Alcohol/drug	Psychoses	Psychoses	Psychoses	Heart failure	 Chronic	 Heart failure 	 dependence	 dependence				 and shock	obstructive	 and shock 							pulmonary							 disease
- 3	Depressive	Depressive	Depressive	Neuroses	 Chronic	 Simple 	 Simple	 Kidney and 	 neuroses 	 neuroses 	 neuroses 	except	 obstructive 	pneumonia 	 pneumonia	 urinary 				depressive	pulmonary	and pleurisy	and pleurisy	infection					 disease
- 4	Rehabilitation	Neuroses 	 Neuroses 	 Chest	 Heart failure	 Psychoses	 Cardiac	 Cardiac 			 except	 except	 pain	 and shock		arrhythmia	arrhythmia		depressive	depressive
- 5	Esophagitis,	 Esophagitis,	 Esophagitis,	 Depressive	 Chest	 Cardiac	 Esophagitis,	 Misc. 	other	other	other	neuroses	pain	arrhythmia	other	metabolic dx	 digestive 	 digestive	 digestive	 			 digestive	 disorders	 disorders	 disorders				 disorders

**Rank Ordered Hospital Discharges ****Among VA System Users by Age**

- Discharge Type: Orange – Psychiatric; Purple – Medical
- From FY1997 through first half FY2001

**18–24**

**Rank**

**25–34**

**35–44**

**45–54**

**55–64**

**65–74**

**75–84**

**85+**

**Notes:**
A total of 60% of all hospital discharge diagnoses were medical, 18% surgical, and 22% psychiatric.

The two leading causes of hospitalizations among VA system users are psychoses for hospitalized veterans less than 35 years of age, and alcohol and drug dependence for those 35 through 64 years of age. In 2000, these two conditions accounted for 97,000 discharges, 15% of total discharges.

Chronic obstructive pulmonary disease, heart failure, and pneumonia rank as top discharge diagnoses for users aged 65 to 74, 75 to 84, and 85 and older, respectively.

Mental disorders comprise 4 of the top 5 hospital discharge diagnoses for system users aged 25 through 54, and account for 41% of all discharges among those aged 45 to 54.

## Rank Ordered Hospital Discharges Among VA System Users by Gender

- Discharge Type: Orange – Psychiatric; Purple – Medical
- From FY1997 through first half FY2001

**Rank Ordered Hospital Discharges ****Among VA System Users by Gender**

- 1	Psychoses	Alcohol/drug dependence
- 2	Alcohol/drug dependence	Psychoses
- 3	Esophagitis,	 Heart failure and shock 	other digestive disorders
- 4	Neuroses, 	Chronic obstructive 	 except depressive 	pulmonary disease
- 5	Depressive neuroses	Simple pneumonia 		and pleurisy

**Notes:**
Four of the top five reasons for hospitalization among female system users are mental disorders, with psychoses, and alcohol and drug dependence being the top two. These two conditions account for 24% of total discharges for women. 

The top two discharge diagnoses are the same for male system users as for female users, but alcohol and drug dependence is ranked first. Men are also primarily hospitalized for medical conditions. 

## Average Length of Stay per Hospitalized User With Diagnosed Cardiovascular Conditions

**Average Length of Hospital Stay (Days)**

- 0

- 10

- 20

- 30

- 35

- Hypertension

- Ischemic Heart Disease

- Hyperlipidemia

- Cardiac Dysrhythmia

- Congestive Heart Failure

**Average Length of Stay per Hospitalized User With Diagnosed Cardiovascular Conditions**

- 25

- 15

- 5

**          ****Overall average length of stay**
**From FY1997 through first half FY2001**

**Notes:**
The overall average length of stay (LOS) for a veteran admitted to the hospital was 12.5 days. 

This figure represents the lengths of stay for hospitalized veterans diagnosed with the conditions listed, though not necessarily admitted for these conditions.

Users diagnosed with hypertension had an average LOS of 10.4 days, shorter than the overall average LOS.

Users diagnosed with other cardiovascular diseases (hypertension, ischemic heart disease, hyperlipidemia, cardiac dysrhythmia, and congestive heart failure) also had lower than average LOS. 
The average LOS for system users diagnosed with any heart disease (including the conditions listed above) was 10.4 days.
Note: The average Length of Stay (LOS) in days is calculated as the total number of acute bed days of care in a time period divided by the number of discharges in that time period.

## Average Length of Stay per Hospitalized User With Diagnosed Chronic Conditions

**Average Length of Stay per Hospitalized User With Diagnosed Chronic Conditions**

**Average Length of Hospital Stay (Days)**

- 0

- 10

- 20

- 30

- 35

- 25

- 15

- 5

**          ****Overall average length of stay**
*** Human Immunodeficiency Virus**
**From FY1997 through first half FY2001**

- Diabetes

- Chronic Obstructive Pulmonary Disease

- Pneumonia

- Cerebrovascular Disease

- Peripheral Arterial Disease

- Arthropathies

- Cancer

- Epilepsy

- HIV*

**Notes:**
The overall average length of stay (LOS) for a veteran admitted to the hospital was 12.5 days. 

This figure represents the lengths of stay for hospitalized veterans diagnosed with the conditions listed, though not necessarily admitted for these conditions.

Hospitalized veterans with diagnosed diabetes, chronic obstructive pulmonary disease, or arthropathies had a lower than average LOS.

Veterans diagnosed with pneumonia and epilepsy had a higher than average LOS, 14.7 and 14.5 days, respectively.

Note: The average Length of Stay (LOS) in days is calculated as the total number of acute bed days of care in a time period divided by the number of discharges in that time period.

## Average Length of Stay per Hospitalized User With Diagnosed Mental Disorders or Alzheimer’s Disease

**          ****Overall average length of stay**
***Excludes Schizophrenia**
**From FY1997 through first half FY2001**

**Average Length of Hospital Stay (Days)**

- 0

- 10

- 20

- 30

- 35

- Senile, Pre-senile Organic, Other Psychotic Conditions*

- Depression

- Alcohol and Drug Dependence

- Schizophrenia

- Alzheimer’s Disease

- 25

- 15

- 5

**Average Length of Stay per Hospitalized User With Diagnosed Mental Disorders or Alzheimer’s Disease**

**Notes:**
The overall average length of stay (LOS) for a veteran admitted to the hospital was 12.5 days. 

This figure represents the lengths of stay for hospitalized veterans diagnosed with the conditions listed, though not necessarily admitted for these conditions.

Inpatients diagnosed with schizophrenia had twice the average LOS, 25.9 days, and those with a diagnosis of Alzheimer’s Disease averaged 32.6 days per inpatient stay.

Users diagnosed with any mental disorder, excluding Alzheimer’s disease, had an average length of stay of 14.4 days 

Note: The average Length of Stay (LOS) in days is calculated as the total number of acute bed days of care in a time period divided by the number of discharges in that time period.

## Average Number of Principal Medicine Visits per VA System User With Diagnosed Cardiovascular Conditions, FY2000

**Average Number of Visits per System User**

- 0

- 4

- 8

- 10

- Hypertension

- Ischemic Heart Disease

- Hyperlipidemia

- Cardiac Dysrhythmia

- Congestive Heart Failure

- 6

- 2

**          ****Overall average visits per system user**
**FY2000**

**Average Number of Principal Medicine Visits per VA System User With Diagnosed Cardiovascular Conditions, FY2000**

**Notes:**
Principal medicine visits are outpatient visits to VA staff for longitudinal primary care and do not include psychiatry visits or consultations with other medical specialists not providing general medical care.
3.3 million VA system users made an estimated 11 million visits to principal medicine physicians in FY2000, an average of 3.3 visits per VA system user.
Users with the cardiac conditions listed (hypertension, ischemic heart disease, hyperlipidemia, cardiac dysrhythmia, or congestive heart failure) had higher than average numbers of principal medicine visits in 2000, ranging from 3.5 to 4.7 visits per system user.
Although congestive heart failure ranked first among these cardiac conditions, with 4.7 visits per user, its prevalence is relatively low (8%) compared with other the cardiovascular diseases shown, resulting in lower absolute numbers of users accessing primary care.
In FY2000, the average number of principal medicine visits per system user with any diagnosed heart disease (including those shown on this slide) was 4.1. 
Note: The average number of principal medicine visits per user is calculated as the total number of principal medicine visits in a time period divided by the total number of system users in that time period.

## Average Number of Principal Medicine Visits per VA System User With Diagnosed Chronic Conditions, FY2000

- 0

- 2

- 4

- 6

- 8

- 10

**Average Number of Visits per System User**

**	****       ****Overall average number of visits**
*** Human Immunodeficiency Virus**
**FY2000**

- HIV*

- Epilepsy

- Cancer

- Arthropathies

- Peripheral Arterial Disease

- Cerebrovascular Disease

- Pneumonia

- Chronic Obstructive Pulmonary Disease

- Diabetes

**Notes:**
Principal medicine visits are outpatient visits to VA staff for longitudinal primary care and do not include psychiatry visits or consultations with other medical specialists not providing general medical care.

3.3 million VA system users made an estimated 11 million visits to principal medicine physicians in FY2000, an average of 3.3 visits per VA system user.

Among users with other chronic conditions, those with HIV stood out with twice the average number of principal medicine visits per year (7.1), although their absolute numbers of system users were low (18,286 in 2000).
System users with diabetes, by comparison, averaged 4.5 principal medicine visits per user. With an 18% prevalence rate for this condition, they are heavy primary care users. 

Note: The average number of principal medicine visits per user is calculated as the total number of principal medicine visits in a time period divided by the total number of system users in that time period.

## Average Number of Principal Medicine Visits per VA System User With Diagnosed Mental Disorders or Alzheimer’s Disease, FY2000

- 0

- 2

- 4

- 6

- 8

- 10

**          ****Overall average number of visits**
***Excludes Schizophrenia **
**FY2000**

- Alcohol and Drug Dependence

- Senile, Pre-senile Organic, Other Psychotic Conditions*

- Alzheimer’s Disease

- Schizophrenia

- Depression

**Average Number of Visits per System User**

**Notes:**
Principal medicine visits are outpatient visits to VA staff for longitudinal primary care and do not include psychiatry visits or consultations with other medical specialists not providing general medical care.

3.3 million VA system users made an estimated 11 million visits to principal medicine physicians in FY2000, an average of 3.3 visits per VA system user.

Principal medicine visits among veterans with mental disorders were somewhat higher than average for those with schizophrenia (3.8), depression (3.6), and senile, pre-senile organic, and other psychotic conditions (3.6) (excludes Schizophrenia), but somewhat lower for those with alcohol and drug dependence (3.0) and Alzheimer’s Disease (2.3).

Note: The average number of principal medicine visits per user is calculated as the total number of principal medicine visits in a time period divided by the total number of system users in that time period.

## Average Number of Psychiatric Outpatient Visits per VA System User With Diagnosed Mental Disorders or Alzheimer’s Disease, FY2000

- 0

- 5

- 10

- 15

- 20

- 25

**        ****Overall average number of psychiatric visits per system user**
***Excludes Schizophrenia**
**FY2000**

- Alcohol and Drug Dependence

- Senile, Pre-senile Organic, Other Psychotic Conditions*

- Alzheimer’s Disease

- Schizophrenia

- Depression

**Average Number of Visits per System User**

**Notes:**
Psychiatric outpatient visits are those made to VA psychiatrists and are tallied separately for system users with any diagnosed mental disorder.

In FY2000, an average of 7.8 visits to psychiatrists were made per user with any diagnosed mental disorder, exluding Alzheimer’s Disease.

Veterans with diagnosed alcohol and drug dependence or schizophrenia were both substantial users of psychiatric outpatient services, with more than twice the average number of visits (21.8 and 17.7, respectively).

Users with Alzheimer’s Disease averaged 1 outpatient visit per year to a psychiatrist. 

Note: The average number of psychiatric outpatient visits per user is calculated as the total number of psychiatric outpatient visits in a time period divided by the total number of system users in that time period.

## Summary

## Summary

- The number of VA system users accessing VA medical care is increasing yearly
- Prevalent chronic conditions among VA users include hypertension, arthropathies, ischemic heart disease, and hyperlipidemia
- 37% of VA system users have a diagnosis of a mental disorder
- Utilization of VA services by system users with mental disorders is greater than utilization by the average system user

**Notes:**
Between FY1997 and FY2001, the number of veterans seeking care from the VA increased by over 40% (2.7 million in FY1997 to 3.7 million in FY2001).

Younger and older veterans alike seek medical care from the VA.

With increasing age, cardiovascular and other chronic conditions increase in prevalence. The top ranked conditions among VA system users are hypertension, arthropathies, ischemic heart disease, and hyperlipidemia.

Younger users are more likely to have a diagnosis of a mental disorder.

37% of VA medical care system users are diagnosed with a mental disorder, and their use of VA resources is greater than that of others.

## Appendix

## Diagnostic Classifications Used in Tables     and Figures

- Alcohol and Drug Dependence	303, 304
- Alzheimer’s Disease	331.0
- Arthropathies	710-719
- Cardiac Dysrhythmia	427
- Cerebrovascular Disease	430–438
- Chronic Obstructive Pulmonary Disease 	490–496
- Congestive Heart Failure	428
- Depression	311
- Diabetes 	250
- Epilepsy	345
- Heart Disease	391–392.0, 393–398, 	402, 404, 410–416, 	420–429
- Human Immunodeficiency Virus	042, 079.53, V08

**Condition**

**ICD-9-CM**

**Diagnostic Classifications Used in Tables     ****and Figures**

**Notes:**
This slide shows the diagnostic criteria used for classifying individuals with chronic conditions during the time period FY1997 through the first half of FY2001.

Prevalence of chronic conditions was determined by an ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis code entered on the veteran’s medical record.

## Diagnostic Classifications Used in Tables   and Figures (continued)

- Hyperlipidemia	272.4
- Hypertension	401–405
- Ischemic Heart Disease	410–414
- Malignant Neoplasms	140–208, 230–234
- Mental Disorders	290–316
- Peripheral Arterial Disease	250.7, 440.0, 440.2, 	440.3, 440.8, 440.9, 	443.8, 443.9, 444.0, 	444.1, 444.2, 	444.8, 444.9
- Pneumonia	480–486
- Schizophrenic Disorders	295
- Senile and Pre-senile 	290, 294,Organic, Other Psychotic Conditions	296–299

**Condition**

**ICD-9-CM**

**Diagnostic Classifications Used in Tables   ****and Figures (continued)**

**Notes:**
This slide shows the diagnostic criteria used for classifying individuals with chronic conditions during the time period FY1997 through the first half of FY2001.

Prevalence of chronic conditions was determined by an ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis code entered on the veteran’s medical record.

## Diagnosis Related Groups Used in Hospital Discharge Tables 

**Diagnosis Related Groups Used ****in Hospital Discharge Tables**** **

- Alcohol and drug dependence	433
- Cardiac Arrhythmia, conduct diagnosis	138
- Chest pain 	143
- Chronic obstructive pulmonary disease 	88
- Depressive neuroses 	426
- Esophagitis, other digestive disorders 	182
- Heart failure and shock	127
- Kidney and urinary infection 	320
- Miscellaneous metabolic diagnoses 	296
- Neuroses except depressive	427
- Psychoses 	430
- Rehabilitation 	462
- Simple pneumonia and pleurisy 	89

**ADRG**

**Discharge Diagnosis**

**Notes:**
ADRGs (Adjacent Diagnosis Related Group)- Groupings of Diagnosis Related Groups (DRGs) that differ only on the presence or absence of complications and comorbidities, or that were divided by age groups. 

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