1Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
Med Care Res Rev. 2013 Oct;70(5):497-513. doi: 10.1177/1077558713495454. Epub 2013 Jul 17.
Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans' usual source of primary care in a retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes in 2001 to 2004. Underprovision of quality of diabetes care was more common than overprovision. In adjusted analyses, veterans who relied only on Medicare fee-for-service (FFS) for primary care were more likely to be underprovided HbA1c testing than veterans who relied only on Veteran Affairs (VA) for primary care. Dual users of VA and Medicare FFS primary care were significantly more likely to be overprovided HbA1c and microalbumin testing than VA-only users. VA and Medicare providers may need to coordinate more effectively to ensure appropriate diabetes care to Medicare-eligible veterans, because VA reliance was a stronger predictor than care continuity.
患者可以通过不同的医疗保健系统获得服务，例如符合医疗保险条件的退伍军人，他们可以在两个或两个以上的医疗系统中获得服务。我们通过对 2001 年至 2004 年间的 1867 名符合医疗保险条件的糖尿病退伍军人进行回顾性队列研究，调查了糖尿病护理的连续性或退伍军人的常规初级保健与护理质量之间的关系。糖尿病护理质量不足的情况比过度提供的情况更为常见。在调整后的分析中，仅依靠医疗保险按服务收费（FFS）进行初级保健的退伍军人比仅依靠退伍军人事务部（VA）进行初级保健的退伍军人更有可能接受不足的糖化血红蛋白检测。同时使用 VA 和 Medicare FFS 初级保健的退伍军人接受糖化血红蛋白和微量白蛋白检测的过度提供的可能性明显高于仅使用 VA 的退伍军人。VA 和医疗保险提供者可能需要更有效地协调，以确保向符合医疗保险条件的退伍军人提供适当的糖尿病护理，因为 VA 的依赖是比护理连续性更强的预测因素。
