The concurrent use of multiple health care systems may duplicate or fragment care. We assessed the characteristics of veterans who were dually enrolled in both the Veterans Affairs () health care system and a Medicare Advantage () plan, and compared intermediate quality outcomes among those exclusively receiving care in the with those receiving care in both systems.
Data Sources/Study Setting
and quality and administrative data from 2008 to 2009.
We used propensity score methods to test the association between dual use and five intermediate outcome quality measures. Outcomes included control of cholesterol, blood pressure, and glycosylated hemoglobin among persons with coronary heart disease (), hypertension, and diabetes.
Data Collection/Extraction Methods
and data were merged to identify ‐only users ( = 1,637) and dual‐system users ( = 5,006).
We found no significant differences in intermediate outcomes between ‐only and dual‐user populations. Differences ranged from a 3.2 percentage point (95 percent : −1.8 to 8.2) greater rate of controlled cholesterol among ‐only users with to a 2.2 percentage point (95 percent : −2.4 to 6.6) greater rate of controlled blood pressure among dual users with diabetes.
For the five measures studied, we did not find evidence that veterans with dual use of and care experienced improved or worsened outcomes as compared with veterans who exclusively used care.
