Department of Veterans Affairs-Medicare dual beneficiaries with stroke: where do they get care?
This study examined care patterns among stroke patients with diabetes who were dually eligible for Department of Veterans Affairs (VA) and Medicare services. We investigated the location (VA hospital or community-based hospital reimbursed by Medicare) of initial and postacute stroke care during a 1-year follow-up period. We used logistic regression to identify the factors associated with the locations of initial and subsequent stroke care. Of the 6,699 patients studied, 76% received their initial care at a Medicare-reimbursed hospital ("Medicare-first" patients) and 24% at a VA hospital ("VA-first" patients). Patients who were white, married, female, or living farther from the VA were more likely to be Medicare-first patients. During the follow-up period, Medicare-first patients were more likely not only to seek further care but also to use the dual systems than were VA-first patients (71% vs 49%, respectively). The high rates of dual-system use highlight the need for care coordination across systems to address issues of care duplication and continuity.
Center for Healthcare Knowledge Management, VA East Orange Medical Center, VA New Jersey Healthcare System, East Orange, NJ 07018, USA. yujing.shen@va.gov
Yujing
Y
Shen
Patricia A
PA
Findley
Miriam
M
Maney
Leonard
L
Pogach
Stephen
S
Crystal
Mangala
M
Rajan
Thomas W
TW
Findley
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000191:economics*; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics