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Assessing Healthcare Utilization among American Indian and Alaska Native Veterans


In 2003, the Veterans Health Administration (VHA) and Indian Health Service (IHS) executed an agreement to share resources to improve access and health outcomes for American Indian and Alaska Native (AIAN) Veterans. Complicating this goal was the scarcity of information about the extent of dual use in Tribal communities, the types of services accessed across healthcare systems, and potential overlaps in care between VA and IHS. This study sought to fill this knowledge gap. Investigators analyzed VA and IHS administrative data from FY02 and FY03 for 64,746 IHS enrollees who used VA and/or IHS. Most patients used either VA (28%) or IHS (46%) healthcare services, while 25% used both VA and IHS services. [Of the 64,746 enrollees, 2468 were non-Veterans in the dual-user group who received care at VA facilities through sharing and other agreements.]

Findings show that like other VA healthcare users, AIAN patients had the same three most frequent diagnoses associated with healthcare encounters: post-traumatic stress disorder, hypertension, and diabetes. VHA-IHS dual-users were more likely to receive primary care from IHS and to receive diagnostic and behavioral healthcare from VA. Many dual-users who had been diagnosed with diabetes, hypertension, and/or cardiovascular disease received overlapping healthcare services in VA and IHS. Therefore, authors suggest that strategies to improve outcomes among the AIAN Veteran population should target those receiving care in both systems and include information sharing or coordination of clinical care to reduce the potential for duplication and for treatment conflicts.

PubMed Logo Kramer B, Wang M, Jouldjian S, Lee M, Finke B, and Saliba D. Veterans Health Administration and Indian Health Service: Healthcare utilization by Indian Health Service enrollees. Medical Care June 2009;47(6):670-676.

This study was funded through HSR&D. Drs. Kramer and Jouldjian are part of the VA Greater Los Angeles Healthcare System; Ms. Wang and Drs. Lee and Saliba are part of HSR&D’s Center for the Study of Healthcare Provider Behavior in Sepulveda.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.