Related Experiment Video
Updated: Jan 6, 2026
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
All-Cause Mortality Following Veterans Affairs and Community Mental Health Residential Treatment
Gregory M Dams1, Bethany R Ketchen2, Noelle B Smith3,4,5
1Program Evaluation and Resource Center, Office of Mental Health and Office of Suicide Prevention, Veterans Health Administration, Menlo Park, California.
Importance:
The US Department of Veterans Affairs (VA) reports high demand for mental health residential treatment, which is partially met by private sector care paid for by VA. Little is known about the clinical quality of community programs relative to VA residential treatment.
Objective:
To assess whether mental health residential care in VA hospitals provides higher-quality care than non-VA programs by examining posttreatment all-cause mortality in matched veterans.
Design, Setting, And Participants:
Retrospective administrative data on 26 464 veterans discharged from their first mental health residential stay between October 1, 2022, and September 30, 2023, were extracted and propensity score matched using an observational/quasi-experimental case-control design to compare VA residential care with VA-paid community residential care.
Main Outcomes And Measures:
All-cause mortality outcomes of matched veterans postdischarge by setting, VA residential treatment compared with VA-paid community residential treatment, using propensity score matching.
Results:
The study sample consisted of matched veterans discharged from VA-paid community residential treatment (n = 7143; median [SD] age, 51.23 [13.29] years; 10.5% female) compared with similar veterans discharged from VA mental health residential treatment (n = 19 321; median [SD] age, 53.57 [12.96] years; 9.1% female) on age, emergency department use, and medical and mental health diagnoses in the year prior to admission. Propensity score-weighted Cox proportional hazards analyses found that, if veterans attending VA-paid community residential treatment had instead discharged from VA residential treatment, they would be estimated to have relatively lower postdischarge mortality rates at 9 months (b = -0.22; robust SE = 0.09; exponentiated value of the slope coefficient [Exp (b)] = 0.81; 95% CI, 0.86-0.95; z = -2.51; P = .01) and 12 months (b = -0.32; robust SE = 0.07; Exp [b] = 0.73; 95% CI, 0.63-0.84; z = -4.29; P < .001).
Conclusions And Relevance:
Case-control analyses indicate that VA mental health residential treatment demonstrates higher clinical quality compared with VA-paid community residential treatment as evidenced by lower posttreatment all-cause mortality in next year. Additional assessment of cost-benefit tradeoffs is needed.
Related Concept Videos
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
01:30Specialized Care Centers and Settings-I
Daycare centers
They provide several functions. Some facilities care for healthy newborns and children whose parents work, while others are medically focused and care for...
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:19Restorative Care
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:27Post-traumatic Stress Disorder
Symptoms and Behavioral Manifestations
A spectrum of distressing symptoms characterizes PTSD. Recurrent flashbacks, where individuals involuntarily relive traumatic events,...