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The continuity and quality of primary care
Matthew L Maciejewski1, Virginia Wang, James F Burgess
11Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
Medical Care Research and Review : MCRR
|July 23, 2013
Summary
For Medicare veterans with diabetes, relying solely on the Veteran Affairs (VA) health system ensures better diabetes care quality than using Medicare fee-for-service (FFS). Dual use of VA and Medicare FFS leads to overtesting.
Area of Science:
- Health Services Research
- Diabetes Care Quality
- Veteran Health Administration
Background:
- Medicare-eligible veterans may access care through both Medicare and the Veteran Affairs (VA) health systems.
- Understanding how care source impacts diabetes care quality is crucial for this population.
- Care continuity and usual source of care are key factors in healthcare delivery.
Purpose of the Study:
- To investigate the association between the usual source of primary care and the quality of diabetes care among Medicare-eligible veterans.
- To determine if care continuity influences diabetes care quality in veterans using multiple health systems.
- To compare diabetes care quality between veterans using only VA, only Medicare FFS, or both.
Main Methods:
- Retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes (2001-2004).
- Analysis of diabetes care quality indicators, including HbA1c testing and microalbumin testing.
- Adjusted analyses to control for potential confounding factors.
Main Results:
- Underprovision of diabetes care quality was more prevalent than overprovision.
- Veterans using only Medicare fee-for-service (FFS) were more likely to have underprovided HbA1c testing compared to VA-only users.
- Dual users of VA and Medicare FFS were more likely to have overprovided HbA1c and microalbumin testing than VA-only users.
Conclusions:
- Reliance on the Veteran Affairs (VA) health system was a stronger predictor of diabetes care quality than care continuity.
- Effective coordination between VA and Medicare providers is essential for optimizing diabetes care for eligible veterans.
- Current care models may lead to disparities in diabetes testing for veterans using mixed healthcare systems.
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