title: Dual use of Veterans Affairs services and use of recommended ambulatory care.
abstract: BACKGROUND
  Use of more than one health care system to obtain care is common among adults receiving care within the Veterans Affairs (VA) medical system. It is not known what effect using care from multiple sources has on the quality of care patients receive.
  
  
  OBJECTIVE
  To examine whether use of recommended ambulatory care services differs between exclusive and dual VA users.
  
  
  METHODS
  Cross-sectional analysis of the 2004 Behavior Risk Factor Surveillance System, a nationally-representative survey of community-dwelling adults aged 18 years or older. Our outcome measures were self-reported use of 18 recommended services for cancer prevention, cardiovascular risk reduction, diabetes management, and infectious disease prevention. We used multivariable logistic regression to examine the association between exclusive and dual VA use and use of recommended ambulatory services.
  
  
  RESULTS
  There were 3470 exclusive VA users and 4523 dual VA users. Dual users were significantly more likely to be older and white, have higher incomes, have graduated from college, and be insured when compared with exclusive VA users. In unadjusted analyses, dual users received higher rates of recommended services. After adjustment for patient characteristics, use of recommended services was largely similar among exclusive and dual VA users. Exclusive VA users reported 14% greater use of breast cancer screening and 10% greater use of cholesterol monitoring among patients with hypercholesterolemia, and 6% lower use of prostate cancer screening and 7% lower use of influenza vaccination.
  
  
  CONCLUSIONS
  After adjustment for patient characteristics, exclusive and dual VA users reported similar rates of recommended ambulatory service use.
authors.affiliation: HSR&D Targeted Research Enhancement Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, New York 10468, USA. joseph.ross@va.gov
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Keenan
authors.forename: Susannah M
authors.initials: SM
authors.lastname: Bernheim
authors.forename: Joan D
authors.initials: JD
authors.lastname: Penrod
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Boockvar
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D040343:Behavioral Risk Factor Surveillance System; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration*; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*