2. 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 Health Services Research and Development Service, ACC 03-304 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 Photo: Maxine Judkins Methods: Administrative data Organizational survey Focus groups Expert panel

4. VHAIHS Service states5035 States with hospitals5013 Entitlement  Background:  VHA-IHS Memorandum of Understanding, 2003  VHA and IHS resources Overview: “VHA and IHS: Access for American Indian and Alaska Native Veterans”  High rates of military participation

5. Background American 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 All AIAN who used IHS and/or VHA N=64,746 Women N=5,856 (9%) Linked and merged FY 02 and FY 03 data: VHA - National Patient Care Database IHS – National Patient Information Reporting System

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

9. Study population: Limitations VHA-onlyIHS-only Dual Users 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 non-veterans veterans IHS-only users 36% VHA-only users 24% N = 5,856 Dual users 40%

11. Non-veteran dual users of VHA

12. IHS-onlyVHA-onlyDual users Age (mean) in years41.447.344.0 % Wartime57%58% Service connected injury or illness, %* (all AIAN) < 50% service connected (AIAN men) > 50% service connected (all AIAN) 46% (41%) 25.6% (21.9%) 20.5% (18.7%) 40% (39%) 25.1% (20.7%) 14.6% (17.5%) Characteristics: AIAN Women * Veterans only

13. Medical diagnoses: AIAN female veterans *Outpatient Top dx in rank order* VHA FY03 IHS only VHA onlyDual users Diabetes(3)141 Hypertension(1)232 Depression323 PTSD(2)14 Hyperthyroidism410 Esophageal Reflex68

14. Veterans’ use of VHA and/or IHS % outpatient encounters by user groups n=2,774n=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 35 IHS Service States

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

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

17. 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. Summary

18. 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. Policy Implications

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