Zhu Carolyn W, Penrod Joan D, Ross Joseph S, Dellenbaugh Cornelia, Sano Mary
Research Enhancement Award Program and Geriatric Research, Health Services Research and Development Service, James J. Peters Veterans Affairs Medical Center, Bronx, New York 10468, USA.
J Am Geriatr Soc. 2009 Oct;57(10):1908-14. doi: 10.1111/j.1532-5415.2009.02405.x. Epub 2009 Aug 13.
The objectives of this study were to examine longitudinal patterns of Department of Veterans Affairs (VA)-only use, dual VA and Medicare use, and Medicare-only use by veterans with dementia. Data on VA and Medicare use were obtained from VA administrative datasets and Medicare claims (1998-2001) for 2,137 male veterans who, in 1997, used some VA services, had a formal diagnosis of Alzheimer's disease or vascular dementia in the VA, and were aged 65 and older. Generalized ordered logit models were used to estimate the effects of patient characteristics on use group over time. In 1998, 41.7% of the sample were VA-only users, 55.4% were dual users, and 2.9% were Medicare-only users. By 2001, 30.4% were VA-only users, 51.5% were dual users, and 18.1% were Medicare-only users. Multivariate results show that greater likelihood of Medicare use was associated with older age, being white, being married, having higher education, having private insurance or Medicaid, having low VA priority level, and living in a nursing home or dying during the year. Higher comorbidities were associated with greater likelihood of dual use as opposed to any single system use. Alternatively, number of functional limitations was associated with greater likelihood of Medicare-only use and less likelihood of VA-only use. These results imply that different aspects of veterans' needs have differential effects on where they seek care. Efforts to coordinate care between VA and Medicare providers are necessary to ensure that patients receive high-quality care, especially patients with multiple comorbidities.
本研究的目的是调查患有痴呆症的退伍军人仅使用退伍军人事务部（VA）服务、同时使用VA和医疗保险以及仅使用医疗保险的纵向模式。VA和医疗保险使用数据来自VA行政数据集以及1998 - 2001年医疗保险理赔记录，涉及2137名男性退伍军人，这些退伍军人在1997年使用过一些VA服务，在VA被正式诊断患有阿尔茨海默病或血管性痴呆，且年龄在65岁及以上。使用广义有序logit模型来估计患者特征随时间对使用类别产生的影响。1998年，样本中41.7%为仅使用VA服务的用户，55.4%为同时使用两者的用户，2.9%为仅使用医疗保险的用户。到2001年，30.4%为仅使用VA服务的用户，51.5%为同时使用两者的用户，18.1%为仅使用医疗保险的用户。多变量结果显示，医疗保险使用可能性增加与年龄较大、白人、已婚、教育程度较高、拥有私人保险或医疗补助、VA优先级较低以及当年居住在养老院或死亡有关。较高的合并症与同时使用两者而非仅使用单一系统的可能性增加有关。另外，功能受限数量与仅使用医疗保险的可能性增加以及仅使用VA服务的可能性降低有关。这些结果表明，退伍军人需求的不同方面对他们寻求护理的地点有不同影响。协调VA和医疗保险提供者之间的护理工作对于确保患者获得高质量护理是必要的，尤其是对于患有多种合并症的患者。
