{Reference Type}: Journal Article
{Title}: Evaluation of regional variation in racial and ethnic differences in patient experience among Veterans Health Administration primary care users.
{Author}: Shannon EM;Jones KT;Moy E;Steers WN;Toyama J;Washington DL;
{Journal}: Health Serv Res
{Volume}: 0
{Issue}: 0
{Year}: 2024 May 29
{Factor}: 3.734
{DOI}: 10.1111/1475-6773.14328
{Abstract}: <B>OBJECTIVE: </B>To evaluate racial and ethnic differences in patient experience among VA primary care users at the Veterans Integrated Service Network (VISN) level.<BR><B>UNASSIGNED: </B>We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients-Patient Centered Medical Home for fiscal years 2016-2019.<BR><B>METHODS: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation.