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Dual use of veterans health administration and Indian Health Service: healthcare provider and patient perspectives.

Abstract：

BACKGROUND:Many American Indian and Alaska Native veterans are eligible for healthcare from Veterans Health Administration (VHA) and from Indian Health Service (IHS). These organizations executed a Memorandum of Understanding in 2003 to share resources, but little was known about how they collaborated to deliver healthcare. OBJECTIVE:To describe dual use from the stakeholders' perspectives, including incentives that encourage cross-use, which organization's primary care is "primary," and the potential problems and opportunities for care coordination across VHA and IHS. PARTICIPANTS:VHA healthcare staff, IHS healthcare staff and American Indian and Alaska Native veterans. APPROACH:Focus groups were conducted using a semi-structured guide. A software-assisted text analysis was performed using grounded theory to develop analytic categories. MAIN RESULTS:Dual use was driven by variation in institutional resources, leading patients to actively manage health-seeking behaviors and IHS providers to make ad hoc recommendations for veterans to seek care at VHA. IHS was the "primary" primary care for dual users. There was little coordination between VHA and IHS resulting in delays and treatment conflicts, but all stakeholder groups welcomed future collaboration. CONCLUSIONS:Fostering closer alignment between VHA and IHS would reduce care fragmentation and improve accountability for patient care.

journal_name

J Gen Intern Med

journal_title

Journal of general internal medicine

authors

Kramer BJ,Vivrette RL,Satter DE,Jouldjian S,McDonald LR

doi

10.1007/s11606-009-0962-4

subject

Has Abstract

pub_date

2009-06-01 00:00:00

pages

758-64

issue

6

eissn

0884-8734

issn

1525-1497

journal_volume

24

pub_type

杂志文章

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