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VHA and Indian Health Service: Access for American Indian & Alaska Native Veterans. Women Veterans. 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
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VHA and Indian Health Service: Access for American Indian & Alaska Native Veterans Women Veterans
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
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
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
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
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
Study Population Linked and merged FY 02 and FY 03 data: VHA - National Patient Care Database IHS – National Patient Information Reporting System
VHA-only Dual Users IHS-only Study population: 3 user groups
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
Healthcare by VHA and/or IHS Dual users 40% non-veterans IHS-only users 36% veterans VHA-only users 24% N = 5,856
Characteristics: AIAN Women * Veterans only
Medical diagnoses: AIAN female veterans *Outpatient
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
Veterans’ use of VHA and/or IHS by state Top 10 states in study population * No IHS hospitals
Dual users: VHA and/or IHS clinics *Dual users include only veterans
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.
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.
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