VHA and Indian Health Service: Access for American Indian & Alaska Native Veterans

1. VHA and Indian Health Service: Access for American Indian & Alaska Native Veterans Women Veterans

2. VHA and Indian Health Service: Access for American Indian & Alaska Native Veterans VA Health Services Research and Development Service, ACC 03-304 B. Josea Kramer, PhD VA Greater LA Healthcare System Geriatric Research Education Clinical Center Bruce Finke, MD Indian Health Service Acting CMO, Nashville Area Elder Health Consultant VA Greater Los Angeles Healthcare System Investigators Elizabeth Yano, PhD Debra Saliba, MD, MPH Stella Sarkisyan, MPH, MSW Donna Washington, MD Laurence Z. Rubenstein, MD, MPH

3. Overview: “VHA and IHS: Access for American Indian and Alaska Native Veterans” Objectives: • Describe AIAN veterans’ health needs • Describe use of VHA and IHS • Inform interagency planning efforts • Methods: • Administrative data • Organizational survey • Focus groups • Expert panel Photo: Maxine Judkins

4. Overview: “VHA and IHS: Access for American Indian and Alaska Native Veterans” • Background: • VHA-IHS Memorandum of Understanding, 2003 • VHA and IHS resources • High rates of military participation

5. BackgroundAmerican Indian Alaska Native Female Veterans Many AIAN women are eligible for care from IHS and VHA • Little is known about AIAN women • health needs • use of VHA and IHS

6. Overview“Federal healthcare for AIAN women veterans” • Demographic and health characteristics • Use of VHA and/or IHS care • Strategies for closer alignment of federal resources Minnie Spotted Wolf WWII – Marine Reserve Corps

7. Study Population Linked and merged FY 02 and FY 03 data: VHA - National Patient Care Database IHS – National Patient Information Reporting System

8. VHA-only Dual Users IHS-only Study population: 3 user groups

9. VHA-only Dual Users IHS-only Study population: Limitations • Does not include the following American Indians and Alaska Natives veterans • Tribally enrolled veterans who are not in IHS-NPIRS • IHS users of urban clinics • Tribal facilities that do not submit data to IHS-NPIRS • IHS-only users may under-report veterans

10. Healthcare by VHA and/or IHS Dual users 40% non-veterans IHS-only users 36% veterans VHA-only users 24% N = 5,856

11. Non-veteran dual users of VHA

12. Characteristics: AIAN Women * Veterans only

13. Medical diagnoses: AIAN female veterans *Outpatient

14. Veterans’ use of VHA and/or IHS% outpatient encounters by user groups 35 IHS Service States % n=2,774 n=1,348 AK, AZ, MT, NE, NV, NM. NC, ND, MN, MS, OK, SD, WY AL, CA, CO, CT, FL, ID, IN, IA, KS, LA, MI, ME, MA, NY, OR, RI, SC, TX, UT, WI, WA *Dual users include only veterans

15. Veterans’ use of VHA and/or IHS by state Top 10 states in study population * No IHS hospitals

16. Dual users: VHA and/or IHS clinics *Dual users include only veterans

17. Summary • High rate of service connected injuries and illness. • PTSD, hypertension, diabetes & depression are prevalent conditions. • Utilization patterns of VHA and/or IHS vary by location and by clinical resources. • There is potential for overlaps in care for veterans who use both VHA and IHS.

18. Policy Implications: Policy Implications • Expanding VHA care to all eligible female AIAN veterans would not require new types of services. • Strategies for closer alignment of VHA and IHS may vary in recognition of utilization patterns. • Coordination mechanisms should be established to reduce the potential for fragmentation of care for all dual users of VHA and IHS.

19. Honoring American Indian women veterans Cora Sinard, Oneida WWI – Army Nurse Mary Cornfield, Seneca Desert Shield/Storm Janet Malcolm, Oneida Viet Nam Era, Army Corps Misty Warren, Choctaw Naval Test Parachutist Eva Mirabel, Taos WWII Air Corps