Racial and Ethnic Differences in Satisfaction with Care Coordination Among VA and non-VA Medicare Beneficiaries.

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.

Relationship between clinical conditions and use of Veterans Affairs health care among Medicare-enrolled veterans.

Objective: To determine how reliance on Veterans Affairs (VA) for medical care among veterans enrolled in Medicare is affected by medical conditions, access, and patient characteristics.

Data Sources/study Setting: Department of Veterans Affairs.

Study Design: We examined reliance on the VA for inpatient, outpatient, and overall medical care among all VA users in fiscal years 2003 and 2004 who were also enrolled in Medicare.

Reduced hospitalization cost for upper gastrointestinal events that occur among elderly veterans who are gastroprotected.

Background & Aims: Despite prescription of gastroprotection among elderly nonsteroidal anti-inflammatory drug (NSAID) users, residual bleeding can still occur. We sought to determine the effect of proton pump inhibitors (PPI) on hospitalization and resource use among veterans in whom an upper gastrointestinal event (UGIE) occurred.

Methods: We identified from national pharmacy records veterans > or =65 years prescribed an NSAID, cyclooxygenase-2 selective NSAID (coxib), or salicylate (>325 mg/day) at any Veterans Affairs (VA) facility (01/01/00-12/31/04).

The association of Medicare drug coverage with use of evidence-based medications in the Veterans Health Administration.

Background: Veterans with Medicare managed-care plans have access to pharmacy benefits outside the Veterans Health Administration (VA), but how this coverage affects use of medications for specific disease conditions within the VA is unclear.

Objective: To examine patterns of pharmacotherapy among patients with diabetes mellitus, ischemic heart disease, and chronic heart failure enrolled in fee-for-service (FFS) or managed-care (HMO) plans and to test whether pharmacy benefit coverage within Medicare is associated with the receipt of evidence-based medications in the VA.

Methods: A retrospective analysis of veterans dually enrolled in the VA and Medicare healthcare systems was conducted.

VHA pharmacy use in veterans with Medicare drug coverage.

Objective: To determine how Medicare benefits affect veterans' use of Veterans Health Administration (VHA) pharmacy services.

Study Design: Retrospective analysis of veterans dually enrolled in the Veterans Health Administration and Medicare healthcare systems.

Methods: We used VHA and Medicare administrative data for calendar year 2002 to examine the effect of Medicare HMO pharmacy benefit levels on VHA pharmacy use.

Does poorer familiarity with Medicare translate into worse access to health care?

Objectives: To examine the relationship between a global measure of Medicare program familiarity and a broad set of measures of actual and perceived healthcare access.

Design: Mailed survey in fall of 2004 (2,997 completed surveys; 53% response rate).

Setting: Metropolitan and nonmetropolitan areas across the United States.

Do secondary conditions explain the relationship between depression and health care cost in women with physical disabilities?

Objective: To examine the influence of depression on health care utilization and costs among women with disabilities and to determine whether the severity of other secondary health conditions affects this association.

Design: A time series of 7 interviews over a 1-year period.

Setting: Large, southern metropolitan area.

Utilization and determinants of adjuvant therapy among older patients who receive curative surgery for pancreatic cancer.

Objective: We conducted a population-based study to describe the utilization, determinants, and survival effects of adjuvant therapies after surgery among older patients with pancreatic cancer.

Methods: Using Surveillance, Epidemiology, and End Results-Medicare data, we identified patients older than 65 years who received surgical resection for pancreatic cancer during 1992-2002. We constructed multiple logistic regression models to examine patient, clinical, and hospital factors associated with receiving adjuvant therapy.