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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?

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Journal of General Internal Medicine Aims and scope Submit manuscript

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.

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Acknowledgements

This research was supported by a grant from the VA Health Services Research and Development, ACC 03–304. This report presents findings and conclusions of the authors; it does not necessarily reflect the opinions or policies of the Department of Veterans Affairs or the Indian Health Service. An earlier version of this paper was presented in a paper session at the Gerontological Society of America, annual scientific meetings in New Orleans, November 2010.

Conflict of Interest

None disclosed.

Institutional Review Board

The project was reviewed and approved by the VA Greater Los Angeles Healthcare System Institutional Review Board, the national Indian Health Service and Tribal Institutional Review Boards as required.

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Authors and Affiliations

  1. VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center, 16111 Plummer Street (11E), Sepulveda, CA, 91343, USA

    B. Josea Kramer PhD, Stella Jouldjian MSW, MPH & Debra Saliba MD, MPH

  2. David Geffen School of Medicine at UCLA, Division of Geriatric Medicine, 10833 Le Conte Ave # 12138, Los Angeles, CA, 90095, USA

    B. Josea Kramer PhD & Debra Saliba MD, MPH

  3. VA Greater Los Angeles Healthcare System, Health Services Research Center of Excellence, 16111 Plummer Street, Sepulveda, CA, 91343, USA

    Mingming Wang MPH, Michael N. Mitchell PhD & Debra Saliba MD, MPH

  4. Consulting Measurement Group, Inc., 2390 Crenshaw Blvd. #110, Torrance, CA, 90501, USA

    Jeff Dang MPH, PhD

  5. Indian Health Service, Nashville Area, 711 Stewarts Ferry Pike, Nashville, TN, 37214, USA

    Bruce Finke MD

  6. UCLA/Jewish Home Borun Center for Gerontological Research, 10945 Le Conte Ave # 2239, Los Angeles, CA, 90095, USA

    Debra Saliba MD, MPH

  7. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA

    Debra Saliba MD, MPH

Authors
  1. B. Josea Kramer PhD
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  2. Stella Jouldjian MSW, MPH
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  3. Mingming Wang MPH
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  4. Jeff Dang MPH, PhD
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  5. Michael N. Mitchell PhD
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  6. Bruce Finke MD
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  7. Debra Saliba MD, MPH
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Corresponding author

Correspondence to B. Josea Kramer PhD.

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Kramer, B.J., Jouldjian, S., Wang, M. et al. Do Correlates of Dual Use by American Indian and Alaska Native Veterans Operate Uniformly Across the Veterans Health Administration and the Indian Health Service?. J GEN INTERN MED 26 (Suppl 2), 662 (2011). https://doi.org/10.1007/s11606-011-1834-2

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  • DOI: https://doi.org/10.1007/s11606-011-1834-2

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