PDF(Pubmed)
Abstract：
UNASSIGNED: Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups.
UNASSIGNED: To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex.
UNASSIGNED: This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022.
UNASSIGNED: The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group.
UNASSIGNED: Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including \"good medical care\" and telehealth as a \"comfortable/great option,\" as were some negative items, including \"long waits/delays in getting care,\" \"transportation/traffic challenges,\" and \"anxiety/stress/fear.\" Reporting \"no impact\" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. \"Impersonal/cursory\" telehealth experiences and the need for \"more personal/attentive\" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect.
UNASSIGNED: In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
UNASSIGNED: To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex.
UNASSIGNED: This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022.
UNASSIGNED: The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group.
UNASSIGNED: Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including \"good medical care\" and telehealth as a \"comfortable/great option,\" as were some negative items, including \"long waits/delays in getting care,\" \"transportation/traffic challenges,\" and \"anxiety/stress/fear.\" Reporting \"no impact\" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. \"Impersonal/cursory\" telehealth experiences and the need for \"more personal/attentive\" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect.
UNASSIGNED: In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
摘要：
■在退伍军人健康管理局（VHA）中推进公平的以患者为中心的护理需要了解独特患者群体的不同体验。
■通过对黑人和白人以及男女退伍军人在VHA的护理经验进行比较定性分析，为改善VHA健康公平性提供综合策略。
■这项定性研究使用了一种称为自由职业者的技术，一种以列表形式引发反应的人类学技术，2021年8月2日至2022年2月9日在城市学术VHA医疗中心。参与者包括患有慢性高血压的退伍军人。单个列表的长度，这些列表中的项目顺序，使用列表中的项目频率来计算每个项目的显著性得分，允许比较不同群体内部和之间的突出单词和主题。参与者被问及目前对VHA护理的看法，过去一年的挑战，虚拟护理，改革建议，种族主义的经验。数据从2022年2月10日至9月30日进行了分析。
■史密斯显著性指数，测量每个单词或短语的频率和排名，对每组进行了计算。
■来自49名退伍军人（12名黑人，12个黑人女性,12个白人,和13名白人女性）按种族（24名黑人和25名白人）和性别（24名男性和25名女性）进行了比较。平均（SD）年龄为64.5（9.2）岁。一些积极的项目在种族和性别上都很突出，包括“良好的医疗保健”和远程医疗作为一个“舒适/伟大的选择，“就像一些负面项目一样，包括“长时间等待/延迟获得护理，“\”运输/交通挑战，\"和\"焦虑/压力/恐惧。种族主义对VHA医疗保健经验的报告“没有影响”在种族和性别上都很明显；但是，与种族有关的非专业治疗和积极避免与种族有关的冲突的报告因种族而异（存在于黑人而非白人参与者中）。人际互动的经验也有所不同。“非个人化/粗略”的远程健康体验以及对“更个人化/细心”护理的需求在女性和黑人参与者中尤为突出，但不是男性或白人参与者，谁将VHA护理与礼貌和尊重联系起来。
■在这项关于退伍军人经历的定性自由学者研究中，不同种族和性别的人际护理经验为改善公平提供了见解，以患者为中心的VHA护理。未来的研究和干预措施可以侧重于识别种族和性别内外更广泛类别的差异，并加强努力，以改善对不同退伍军人群体的尊重和个性化护理。
■通过对黑人和白人以及男女退伍军人在VHA的护理经验进行比较定性分析，为改善VHA健康公平性提供综合策略。
■这项定性研究使用了一种称为自由职业者的技术，一种以列表形式引发反应的人类学技术，2021年8月2日至2022年2月9日在城市学术VHA医疗中心。参与者包括患有慢性高血压的退伍军人。单个列表的长度，这些列表中的项目顺序，使用列表中的项目频率来计算每个项目的显著性得分，允许比较不同群体内部和之间的突出单词和主题。参与者被问及目前对VHA护理的看法，过去一年的挑战，虚拟护理，改革建议，种族主义的经验。数据从2022年2月10日至9月30日进行了分析。
■史密斯显著性指数，测量每个单词或短语的频率和排名，对每组进行了计算。
■来自49名退伍军人（12名黑人，12个黑人女性,12个白人,和13名白人女性）按种族（24名黑人和25名白人）和性别（24名男性和25名女性）进行了比较。平均（SD）年龄为64.5（9.2）岁。一些积极的项目在种族和性别上都很突出，包括“良好的医疗保健”和远程医疗作为一个“舒适/伟大的选择，“就像一些负面项目一样，包括“长时间等待/延迟获得护理，“\”运输/交通挑战，\"和\"焦虑/压力/恐惧。种族主义对VHA医疗保健经验的报告“没有影响”在种族和性别上都很明显；但是，与种族有关的非专业治疗和积极避免与种族有关的冲突的报告因种族而异（存在于黑人而非白人参与者中）。人际互动的经验也有所不同。“非个人化/粗略”的远程健康体验以及对“更个人化/细心”护理的需求在女性和黑人参与者中尤为突出，但不是男性或白人参与者，谁将VHA护理与礼貌和尊重联系起来。
■在这项关于退伍军人经历的定性自由学者研究中，不同种族和性别的人际护理经验为改善公平提供了见解，以患者为中心的VHA护理。未来的研究和干预措施可以侧重于识别种族和性别内外更广泛类别的差异，并加强努力，以改善对不同退伍军人群体的尊重和个性化护理。
