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Volume 45 Number 1, 2008
   Pages 43 — 52

Abstract - Department of Veterans Affairs-Medicare dual beneficiaries with stroke: Where do they get care?

Yujing Shen, PhD;1-2* Patricia A. Findley, DrPH, MSW;1,3 Miriam Maney, MA, CPHQ;1 Leonard Pogach, MD, MBA;1 Stephen Crystal, PhD;2 Mangala Rajan, MBA;1 Thomas W. Findley, MD, PhD1

1Center for Healthcare Knowledge Management, Department of Veterans Affairs (VA) East Orange Medical Center, VA New Jersey Healthcare System, East Orange, NJ; 2Institute for Health, Health Care Policy, and Aging Research and 3School of Social Work, Rutgers University, New Brunswick, NJ

Abstract — This study examined care patterns among stroke patients with diabetes who were dually eligible for Department of Veterans Affairs (VA) and Medicare services. We investigated the location (VA hospital or community-based hospital reimbursed by Medicare) of initial and postacute stroke care during a 1-year follow-up period. We used logistic regression to identify the factors associated with the locations of initial and subsequent stroke care. Of the 6,699 patients studied, 76% received their initial care at a Medicare-reimbursed hospital ("Medicare-first" patients) and 24% at a VA hospital ("VA-first" patients). Patients who were white, married, female, or living farther from the VA were more likely to be Medicare-first patients. During the follow-up period, Medicare-first patients were more likely not only to seek further care but also to use the dual systems than were VA-first patients (71% vs 49%, respectively). The high rates of dual-system use highlight the need for care coordination across systems to address issues of care duplication and continuity.

Key words: care coordination, diabetes, disability, dual enrollment, length of stay, Medicare, rehabilitation, stroke, utilization, veterans.

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