Loganathan Sai K, Hasche Jennifer C, Koenig Kevin T, Haffer Samuel C, Uchendu Uchenna S
NORC at the University of Chicago, Bethesda, Maryland.
NORC at the University of Chicago, Chicago, Illinois.
Health Equity. 2017 Apr 1;1(1):50-60. doi: 10.1089/heq.2016.0012. eCollection 2017.
Patients who have multiple sources of care are at risk for fragmented and uncoordinated care, which can lead to poorer outcomes. Veteran Medicare beneficiaries who use the Veterans Health Administration (VHA) system (VA users), particularly racial/ethnic minorities, often have complex medical conditions that may require care from multiple sources, leaving them especially vulnerable to the effects of fragmented care. We examined racial/ethnic differences in the level of satisfaction with care coordination among Medicare beneficiaries, comparing those who do and do not use the VHA healthcare system. We conducted a retrospective, pooled, cross-sectional study of Medicare beneficiaries using the 2009-2011 Medicare Current Beneficiary Survey. The outcomes are self-reported satisfaction with care items related to three dimensions of care coordination: (1) integrated care, (2) care continuity, and (3) follow-up care. We present descriptive statistics and use generalized linear models to examine racial/ethnic differences across VA and non-VA users, after accounting for other demographic characteristics, health status, functional limitations, insurance coverage, and geographic variation. VA users are more likely to be very satisfied with receiving both integrated and follow-up care compared with non-VA users. Despite the existence of significant racial/ethnic disparities in the likelihood of being very satisfied with receiving well-coordinated care in the larger Medicare population, racial/ethnic minority VA users are just as likely as White non-Hispanics to be very satisfied with receiving well-coordinated care. Future research should continue to study care coordination among VA users and reasons for preferring the VA over other healthcare systems, especially among racial/ethnic minority groups.
有多种医疗服务来源的患者面临着医疗服务碎片化和不协调的风险，这可能导致更差的治疗结果。使用退伍军人健康管理局（VHA）系统的老年医疗保险受益人（即VHA使用者），尤其是少数族裔，往往患有复杂的疾病，可能需要多种来源的医疗服务，这使他们特别容易受到医疗服务碎片化的影响。我们比较了使用和未使用VHA医疗系统的医疗保险受益人在医疗服务协调满意度水平上的种族/民族差异。我们利用2009 - 2011年医疗保险当前受益人调查对医疗保险受益人进行了一项回顾性、汇总性横断面研究。研究结果是对与医疗服务协调三个维度相关的医疗项目的自我报告满意度：（1）综合医疗服务，（2）医疗服务连续性，以及（3）后续医疗服务。在考虑了其他人口统计学特征、健康状况、功能限制、保险覆盖范围和地理差异后，我们呈现描述性统计数据，并使用广义线性模型来检验VHA使用者和非VHA使用者之间的种族/民族差异。与非VHA使用者相比，VHA使用者对获得综合医疗服务和后续医疗服务更有可能非常满意。尽管在更大的医疗保险人群中，对获得协调良好的医疗服务非常满意的可能性存在显著的种族/民族差异，但少数族裔VHA使用者与非西班牙裔白人对获得协调良好的医疗服务非常满意的可能性相同。未来的研究应继续研究VHA使用者之间的医疗服务协调情况，以及他们更喜欢VHA而非其他医疗系统的原因，尤其是在少数族裔群体中。
