PDF(Pubmed)
Abstract：
BACKGROUND: Prior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner.
OBJECTIVE: To examine differences in Veterans\' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021.
METHODS: Observational analyses of Veterans\' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors.
METHODS: Respondents to the 2016-2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey.
METHODS: Care ratings in nine domains.
RESULTS: The sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from - 0.04 to - 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted.
CONCLUSIONS: This study identified small but persistent racial and ethnic differences in Veterans\' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans\' patient experience could advance equity in VA community care.
OBJECTIVE: To examine differences in Veterans\' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021.
METHODS: Observational analyses of Veterans\' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors.
METHODS: Respondents to the 2016-2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey.
METHODS: Care ratings in nine domains.
RESULTS: The sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from - 0.04 to - 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted.
CONCLUSIONS: This study identified small but persistent racial and ethnic differences in Veterans\' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans\' patient experience could advance equity in VA community care.
摘要：
背景：先前的研究记录了退伍军人健康管理局（VA）在医疗保健方面的种族和族裔差异。对于VA资助的社区护理计划中的这种差异知之甚少，越来越多的退伍军人接受医疗保健。当退伍军人管理局无法提供社区护理时，退伍军人可以获得社区护理，附近,或及时。
目标：按种族和族裔检查退伍军人资助的社区护理的经验差异，并评估这些经验在2016年至2021年期间的变化。
方法：根据自我报告的种族和族裔对社区护理经历进行的退伍军人观察性分析。我们使用线性和逻辑回归来估计社区护理经验中的种族和民族差异，根据人口统计顺序调整，健康,保险,和社会经济因素。
方法：2016-2021年VA患者医疗保健经验调查-社区护理调查的受访者。
方法：9个领域的护理评级。
结果：231,869名受访者的样本包括24,306名黑人退伍军人（平均[SD]年龄56.5[12.9]岁，77.5%的男性)和16,490名西班牙裔退伍军人(平均年龄54.6[15.9]岁，85.3%男性）。在跨研究年份汇总的调整分析中，黑人和西班牙裔退伍军人在九个领域中的五个领域中的评分明显低于白人和非西班牙裔退伍军人（社区提供者的总体评分，安排最近的约会，提供商通信，非预约访问，和计费)，调整后的差异范围从-0.04到-0.13的领域得分标准差(SD)。黑人和西班牙裔退伍军人在资格确定和安排初次任命方面的评分高于白人和非西班牙裔退伍军人，黑人退伍军人报告了更高的护理协调评级，调整后的差异为0.05至0.21SDs。从2016年到2021年，护理等级有所提高，但种族和族裔群体之间的差异仍然存在。
结论：这项研究确定了退伍军人在VA资助的社区护理方面经历的微小但持久的种族和民族差异，黑人和西班牙裔退伍军人在五个领域的评级较低，分别,在三个和两个领域的收视率更高。改善黑人和西班牙裔退伍军人患者体验的干预措施可以提高VA社区护理的公平性。
目标：按种族和族裔检查退伍军人资助的社区护理的经验差异，并评估这些经验在2016年至2021年期间的变化。
方法：根据自我报告的种族和族裔对社区护理经历进行的退伍军人观察性分析。我们使用线性和逻辑回归来估计社区护理经验中的种族和民族差异，根据人口统计顺序调整，健康,保险,和社会经济因素。
方法：2016-2021年VA患者医疗保健经验调查-社区护理调查的受访者。
方法：9个领域的护理评级。
结果：231,869名受访者的样本包括24,306名黑人退伍军人（平均[SD]年龄56.5[12.9]岁，77.5%的男性)和16,490名西班牙裔退伍军人(平均年龄54.6[15.9]岁，85.3%男性）。在跨研究年份汇总的调整分析中，黑人和西班牙裔退伍军人在九个领域中的五个领域中的评分明显低于白人和非西班牙裔退伍军人（社区提供者的总体评分，安排最近的约会，提供商通信，非预约访问，和计费)，调整后的差异范围从-0.04到-0.13的领域得分标准差(SD)。黑人和西班牙裔退伍军人在资格确定和安排初次任命方面的评分高于白人和非西班牙裔退伍军人，黑人退伍军人报告了更高的护理协调评级，调整后的差异为0.05至0.21SDs。从2016年到2021年，护理等级有所提高，但种族和族裔群体之间的差异仍然存在。
结论：这项研究确定了退伍军人在VA资助的社区护理方面经历的微小但持久的种族和民族差异，黑人和西班牙裔退伍军人在五个领域的评级较低，分别,在三个和两个领域的收视率更高。改善黑人和西班牙裔退伍军人患者体验的干预措施可以提高VA社区护理的公平性。
