Do Correlates of Dual Use by American Indian and Alaska Native Veterans Operate Uniformly Across the Veterans Health Administration and the Indian Health Service?

  • B. Josea Kramer
  • Stella Jouldjian
  • Mingming Wang
  • Jeff Dang
  • Michael N. Mitchell
  • Bruce Finke
  • Debra Saliba
Original Research

DOI: 10.1007/s11606-011-1834-2

Cite this article as:
Kramer, B.J., Jouldjian, S., Wang, M. et al. J GEN INTERN MED (2011) 26(Suppl 2): 662. doi:10.1007/s11606-011-1834-2

Abstract

OBJECTIVE

To determine if the combined effects of patient-level (demographic and clinical characteristics) and organizational-level (structure and strategies to improve access) factors are uniformly associated with utilization of Indian Health Service (IHS) and/or Veterans Health Administration (VHA) by American Indian and Alaska Native (AIAN) Veterans to inform policy which promotes dual use.

METHODS

We estimated correlates and compared two separate multilevel logistic regression models of VHA-IHS dual versus IHS-only and VHA-IHS dual versus VHA-only in a sample of 18,892 AIAN Veterans receiving care at 201 VHA and IHS facilities during FY02 and FY03. Demographic, diagnostic, eligibility, and utilization data were drawn from administrative records. A survey of VHA and IHS facilities defined availability of services and strategies to enhance access to healthcare for AIAN Veterans.

RESULTS

Facility level strategies that are generally associated with enhancing access to healthcare (e.g., population-based services and programs, transportation or co-location) were not significant factors associated with dual use. In both models the common variable of dual use was related to medical need, defined as the number of diagnoses per patient. Other significant demographic, medical need and organizational factors operated in opposing manners. For instance, age increased the likelihood of dual use versus IHS-only but decreased the likelihood of dual use versus VHA-only.

CONCLUSIONS

Efforts to enhance access through population-based and consumer-driven strategies may add value but be less important to utilization than availability of healthcare resources needed by this population. Sharing health records and co-management strategies would improve quality of care while policies allow and promote dual use.

KEY WORDS

access underserved populations health services research 

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • B. Josea Kramer
    • 1
    • 2
  • Stella Jouldjian
    • 1
  • Mingming Wang
    • 3
  • Jeff Dang
    • 4
  • Michael N. Mitchell
    • 3
  • Bruce Finke
    • 5
  • Debra Saliba
    • 1
    • 2
    • 3
    • 6
    • 7
  1. 1.VA Greater Los Angeles Healthcare SystemGeriatric Research Education Clinical CenterSepulvedaUSA
  2. 2.David Geffen School of Medicine at UCLADivision of Geriatric MedicineLos AngelesUSA
  3. 3.VA Greater Los Angeles Healthcare SystemHealth Services Research Center of ExcellenceSepulvedaUSA
  4. 4.Consulting Measurement Group, Inc.TorranceUSA
  5. 5.Indian Health ServiceNashvilleUSA
  6. 6.UCLA/Jewish Home Borun Center for Gerontological ResearchLos AngelesUSA
  7. 7.RAND CorporationSanta MonicaUSA

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