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Do Correlates of Dual Use by American Indian and Alaska Native Veterans Operate Uniformly Across the Veterans Health Administration and the Indian Health Service?
- Source :
- Journal of General Internal Medicine. 26:662-668
- Publication Year :
- 2011
- Publisher :
- Springer Science and Business Media LLC, 2011.
-
Abstract
- 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.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.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.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.
- Subjects :
- Adult
Male
medicine.medical_specialty
Hospitals, Veterans
Veterans Health
Health Services Accessibility
Underserved Population
Health services
Risk Factors
Environmental health
Internal Medicine
medicine
Humans
health care economics and organizations
Aged
Veterans
Original Research
business.industry
Health services research
Middle Aged
Veterans health
United States
humanities
United States Department of Veterans Affairs
Logistic Models
Family medicine
United States Indian Health Service
Indians, North American
Female
business
Administration (government)
Subjects
Details
- ISSN :
- 15251497 and 08848734
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Journal of General Internal Medicine
- Accession number :
- edsair.doi.dedup.....e4de8d5ba61b301db38350b0451fc03a
- Full Text :
- https://doi.org/10.1007/s11606-011-1834-2