Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #113559

Yujing Shen, PhD¹, Patricia A. Findley, DrPH, MSW², Miriam Maney, MA³, Leonard Pogach, MD, MBA⁴, Mangala Rajan, MBA⁵, and Thomas W. Findley, MD, PHD³. (1) Institute for Health, Health Care Policy and Aging Research, Rutgers, the State University of New Jersey, 30 College Ave., New Brunswick, NJ 08901, 732-932-8148, yshen@ihhcpar.rutgers.edu, (2) Program for Disability Research, Rutgers University, 303 George Street, Suite 405, New Brunswick, NJ 08901, (3) Center for Healthcare Knowledge Management, East Orange VA Medical Center, 385 Tremont Avenue, Mail Stop 129, East Orange, NJ 07018, (4) Center for Healthcare Knowledge Management, New Jersey East Orange VA Hospital, 385 Tremont, VAMC #129, East Orange, NJ 07018, (5) DVA-New Jersey Healthcare System, 385 Tremont Avenue, VAMC #129, East Orange, NJ 07018

Objectives: Many older U.S. veterans are eligible for health care from both Veterans Administration (VA) and Medicare. We examined the dual system use of veterans with stroke.

Study Design: This is a cross-sectional analysis using data from the 1999 VA Diabetes Epidemiology Cohort (DEpiC) which includes VA and Medicare medical encounter files and the 1999 Large Health Survey of Veterans. By merging DEpiC with FY 1999 Medicare denominator file, 1998-2000 Medicare claims data and VA inpatient/outpatient files, we identified patients with full year Medicare Fee-For-Service (FFS) in FY 1999 admitted to the hospital for an incident stroke in FY 99 but did not have a stroke in FY 1998 using Reker-specific Method (N=6,699). We identified those who were admitted to VA hospitals for initial stroke hospitalization as ‘VA-first' and those who were admitted to a community-based hospital reimbursed by Medicare as ‘Medicare-first.' We compared their across-system use during the one-year follow-up period from initial stroke hospitalization.

Population Studied: VA-Medicare dually eligible veterans with stroke who had Medicare FFS in 1999 (N=6,699).

Principal Findings: Overall, 76% were Medicare-first and 24% were VA-first. By the end of the one-year follow-up period, only 22% of the cohort used Medicare exclusively and 12% used VA exclusively. Medicare-first patients were more likely to utilize the other system (VA). 71% of Medicare-first patients received care in the VA while 49.8% of VA-first patients received care in Medicare. Nearly 71% of Medicare-first patients used the VA for outpatient care compared to 44.9% of VA-first patients used Medicare. We found 36.7% of VA-first patients used Medicare for inpatient care compared to 19.2% of Medicare-first patients used the VA. Medicare-first patients stayed in the VA for 62 days compared to 31 days when they remained in Medicare.

Conclusions: Even though a majority of veterans went to the private sector under Medicare for their initial incident stroke, many came to VA for subsequent care, particularly for outpatient visits. VA-first patients were more likely to use Medicare for inpatient care if they crossed systems. Medicare-first patients stayed much longer in the VA when they switched systems.

Implications: The dual system use requires the strategy for coordination of care across systems, not only to address issues of duplication of care, but to also address continuity of care for this complex patient population.

Learning Objectives:

• • The learner will (a) recognize the usefulness of administrative data (the veterans health care system and Medicare) (b) describe the type of care received following a stroke (c) identify patterns of cross system use by VA-Medicare dually eligibles and (d) explain some of the reasons patients may cross systems for care.

Keywords: Coordination, Veterans

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation