2015 National Conference

1160 — Veteran Dual Use: Results of a Systematic Review

LaCoursiere Zucchero TL, CHOIR, VA Bedford & UMass Medical School, Graduate School of Nursing; Vimalananda VG, CHOIR, VA Bedford; Etchin A, Northeastern University; McDannold S, CHOIR, VA Bedford; McInnes DK, CHOIR, VA Bedford;

Objectives:
Dual use, defined as patients receiving health care services from both VA and non-VA settings, is common among Veterans. The purpose of this study was to conduct a systematic review of the literature to assess the state of Veteran dual use research.

Methods:
We searched PubMed, CINAHL, and PsychINFO for peer-reviewed, empirical studies from 2000 through February 2015 that pertained specifically to or included explicit information about Veteran dual use. Because dual use is not included in the Medical Subject Headings, we searched for terms that described the use of multiple health care sources such as "cross-system", "private sector", and "Medicare", as well as variations on the word dual. Following the guidelines of the PRISMA Statement, pairs of reviewers screened studies for eligibility and abstracted data using structured data collection forms.

Results:
Our final review included 102 studies, all of which were descriptive. Most studies reported on the rate of Veteran dual utilization and patient-level factors associated with dual use. The majority of the studies pertained to Medicare enrolled/eligible Veterans. Other subpopulations studied included rural veterans and American Indian/Alaskan Native Veterans. Few studies addressed system-level factors, care coordination, or quality of care associated with dual use.

Implications:
While dual use reflects increased access to care for Veterans, there is little information about features of the healthcare system that encourage or limit dual use, how care is coordinated between VA and non-VA settings, and the impact of dual use on clinical outcomes, costs, and patient and provider experience.

Impacts:
Under the Veterans Access, Choice and Accountability Act of 2014 (VACAA), the number of Veterans who are dual users will increase significantly. Care coordination, a key strategy to improve the effectiveness, safety, and efficiency of health care delivery among multiple providers, will be even more important. Data is needed to help estimate what the impact of increased dual use will be on healthcare quality and the healthcare system, and help guide coordination of care for dual users.