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Shen Y, Findley PA, Maney M, Pogach L, Crystal S, Rajan M, Findley TW. Department of Veterans Affairs-Medicare dual beneficiaries with stroke: where do they get care? Journal of rehabilitation research and development. 2008 Jan 1; 45(1):43-51.
Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects. 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.
