Abstract：
OBJECTIVE: To evaluate racial and ethnic differences in patient experience among VA primary care users at the Veterans Integrated Service Network (VISN) level.
UNASSIGNED: We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients-Patient Centered Medical Home for fiscal years 2016-2019.
METHODS: We compared 28 patient experience measures (six each in the domains of access and care coordination, 16 in the domain of person-centered care) between minoritized racial and ethnic groups (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic, Multi-Race, Native Hawaiian or Other Pacific Islander [NHOPI]) and White Veterans. We used weighted logistic regression to test differences between minoritized and White Veterans, controlling for age and gender.
METHODS: We defined meaningful difference as both statistically significant at two-tailed p < 0.05 with a relative difference ≥10% or ≤-10%. Within VISNs, we included tests of group differences with adequate power to detect meaningful relative differences from a minimum of five comparisons (domain agnostic) per VISN, and separately for a minimum of two for access and care coordination and four for person-centered care domains. We report differences as disparities/large disparities (relative difference ≥10%/≥ 25%), advantages (experience worse or better, respectively, than White patients), or equivalence.
RESULTS: Our analytic sample included 1,038,212 Veterans (0.6% AIAN, 1.4% Asian, 16.9% Black, 7.4% Hispanic, 0.8% Multi-Race, 0.8% NHOPI, 67.7% White). Across VISNs, the greatest proportion of comparisons indicated disparities for three of seven eligible VISNs for AIAN, 6/10 for Asian, 3/4 for Multi-Race, and 2/6 for NHOPI Veterans. The plurality of comparisons indicated advantages or equivalence for 17/18 eligible VISNs for Black and 12/14 for Hispanic Veterans. AIAN, Asian, Multi-Race, and NHOPI groups had more comparisons indicating disparities by VISN in the access domain than person-centered care and care coordination.
CONCLUSIONS: We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation.
UNASSIGNED: We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients-Patient Centered Medical Home for fiscal years 2016-2019.
METHODS: We compared 28 patient experience measures (six each in the domains of access and care coordination, 16 in the domain of person-centered care) between minoritized racial and ethnic groups (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic, Multi-Race, Native Hawaiian or Other Pacific Islander [NHOPI]) and White Veterans. We used weighted logistic regression to test differences between minoritized and White Veterans, controlling for age and gender.
METHODS: We defined meaningful difference as both statistically significant at two-tailed p < 0.05 with a relative difference ≥10% or ≤-10%. Within VISNs, we included tests of group differences with adequate power to detect meaningful relative differences from a minimum of five comparisons (domain agnostic) per VISN, and separately for a minimum of two for access and care coordination and four for person-centered care domains. We report differences as disparities/large disparities (relative difference ≥10%/≥ 25%), advantages (experience worse or better, respectively, than White patients), or equivalence.
RESULTS: Our analytic sample included 1,038,212 Veterans (0.6% AIAN, 1.4% Asian, 16.9% Black, 7.4% Hispanic, 0.8% Multi-Race, 0.8% NHOPI, 67.7% White). Across VISNs, the greatest proportion of comparisons indicated disparities for three of seven eligible VISNs for AIAN, 6/10 for Asian, 3/4 for Multi-Race, and 2/6 for NHOPI Veterans. The plurality of comparisons indicated advantages or equivalence for 17/18 eligible VISNs for Black and 12/14 for Hispanic Veterans. AIAN, Asian, Multi-Race, and NHOPI groups had more comparisons indicating disparities by VISN in the access domain than person-centered care and care coordination.
CONCLUSIONS: We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation.
摘要：
目的：评估退伍军人综合服务网络（VISN）级别的VA初级保健用户在患者体验方面的种族和民族差异。
■我们对2016-2019财年以患者为中心的医疗机构的VA医疗保健体验调查进行了二次分析。
方法：我们比较了28项患者体验指标（在获取和护理协调领域各6项，16在以人为中心的护理领域中）在少数族裔和族裔群体之间（美洲印第安人或阿拉斯加原住民[AIAN]，亚洲人,黑色,西班牙裔,多种族,夏威夷原住民或其他太平洋岛民[NHOPI]）和白退伍军人。我们使用加权逻辑回归来检验成年史和白人退伍军人之间的差异，控制年龄和性别。
方法：我们将有意义的差异定义为双尾p<0.05具有统计学意义，相对差异≥10％或≤-10％。在VISN内,我们纳入了组差异测试，这些测试具有足够的能力，可以从每个VISN的至少五个比较（领域不可知）中检测有意义的相对差异，并分别至少两个用于访问和护理协调，四个用于以人为中心的护理领域。我们将差异报告为差异/大差异(相对差异≥10%/≥25%)，优势(体验更糟或更好，分别,比白人患者更多)，或等价。
结果：我们的分析样本包括1,038,212名退伍军人（0.6%AIAN，1.4%亚洲人，16.9%黑色,7.4%西班牙裔，0.8%多种族，0.8%NHOPI，67.7%白色）。跨VISN，最大比例的比较表明，AIAN的七个合格VISN中有三个存在差异，亚洲6/10，3/4为多种族，NHOPI退伍军人的2/6。多个比较表明黑人的17/18合格VISN和西班牙裔退伍军人的12/14的优点或等效性。AIAN,亚洲人,多种族,与以人为中心的护理和护理协调相比，NHOPI组的比较更多，表明VISN在访问域中的差异。
结论：我们发现，与白种人组相比，各个VISN的患者体验指标存在显著差异。特别是对于人口代表性较低的群体。
■我们对2016-2019财年以患者为中心的医疗机构的VA医疗保健体验调查进行了二次分析。
方法：我们比较了28项患者体验指标（在获取和护理协调领域各6项，16在以人为中心的护理领域中）在少数族裔和族裔群体之间（美洲印第安人或阿拉斯加原住民[AIAN]，亚洲人,黑色,西班牙裔,多种族,夏威夷原住民或其他太平洋岛民[NHOPI]）和白退伍军人。我们使用加权逻辑回归来检验成年史和白人退伍军人之间的差异，控制年龄和性别。
方法：我们将有意义的差异定义为双尾p<0.05具有统计学意义，相对差异≥10％或≤-10％。在VISN内,我们纳入了组差异测试，这些测试具有足够的能力，可以从每个VISN的至少五个比较（领域不可知）中检测有意义的相对差异，并分别至少两个用于访问和护理协调，四个用于以人为中心的护理领域。我们将差异报告为差异/大差异(相对差异≥10%/≥25%)，优势(体验更糟或更好，分别,比白人患者更多)，或等价。
结果：我们的分析样本包括1,038,212名退伍军人（0.6%AIAN，1.4%亚洲人，16.9%黑色,7.4%西班牙裔，0.8%多种族，0.8%NHOPI，67.7%白色）。跨VISN，最大比例的比较表明，AIAN的七个合格VISN中有三个存在差异，亚洲6/10，3/4为多种族，NHOPI退伍军人的2/6。多个比较表明黑人的17/18合格VISN和西班牙裔退伍军人的12/14的优点或等效性。AIAN,亚洲人,多种族,与以人为中心的护理和护理协调相比，NHOPI组的比较更多，表明VISN在访问域中的差异。
结论：我们发现，与白种人组相比，各个VISN的患者体验指标存在显著差异。特别是对于人口代表性较低的群体。
