HEALTH-RELATED QUALITY-OF-LIFE IN PATIENTS SERVED BY THE DEPARTMENT-OF-VETERANS-AFFAIRS - RESULTS FROM THE VETERANS HEALTH STUDY

Background: The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. T o date, there has been no systematic measurement of health status in t he VA. The Veterans Health Study has developed methods to assess patie nt-based health status in ambulatory populations. Objectives: To descr ibe the health status of veterans and examine the relationships betwee n their health-related quality of life, age, comorbidity, and socioeco nomic and service-connected disability status. Methods: Participants i n the Veterans Health Study, a 2-year longitudinal study, were recruit ed from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Stud y patients received questionnaires of health status, including the Med ical Outcomes Study Short Form 36-Item Health Survey; and a health exa mination, clinical assessments, and medical history taking. Sixteen hu ndred sixty-seven patients for whom we conducted baseline assessments are described. Results: The VA outpatients had poor health status scor es across all measures of the Medical Outcomes Study Short Form 36-Ite m Health Survey compared with scores in non-VA populations (at least 5 0% of 1 SD worse). Striking differences also were found with the sampl e stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bod ily pain, general health perceptions, vitality, social functioning, ro le limitations due to emotional problems, and mental health), scores w ere considerably lower among the younger patients; for the eighth scal e (physical function),scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (>65 years) . The mental health scores of young veterans were substantially worse than all other age groups (P<.001) and scores of screening measures fo r depression were significantly higher in the youngest age group (51%) compared with the oldest, age groups (33% and 16%) (P<.001). Conclusi ons: The VA outpatients have substantially worse health status than no n-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; th e young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health- related quality of life in young veterans. As health care systems cont inue to undergo a radical transformation, the Department of Veterans A ffairs should focus on the provision of men, tal health services for i ts younger veteran.