Racial and Ethnic Differences in Satisfaction with Care Coordination Among VA and non-VA Medicare Beneficiaries

Loganathan, Sai; Hasche, Jennifer C.; Koenig, Kevin; Haffer, Samuel C.; Uchendu, Uchenna S.

doi:10.1089/heq.2016.0012

Cited by 3 publications

(2 citation statements)

References 46 publications

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“…For example, Veterans Affairs (VA) health and social benefits may facilitate increased overall access to health care, reduced uninsurance rates, better care coordination, and greater post-service civilian opportunities, such as postsecondary education and increased earnings, among Black Veterans. [7][8][9][10] Military service may also have a "knifing-off" effect of previous experience and disadvantage (i.e., the ability to limit the effects of early negative life events that would otherwise diminish downstream opportunities for advancement). 7,11 Despite the potential benefits of military service, Black-White inequities in the receipt of more effective or curative treatments for pain, cancer, diabetes, and cardiovascular diseases persist among Veterans.…”

Section: Introductionmentioning

confidence: 99%

“…There are reasons to believe that military service could serve to (partially) mitigate racial inequity for some health outcomes. For example, Veterans Affairs (VA) health and social benefits may facilitate increased overall access to health care, reduced uninsurance rates, better care coordination, and greater post‐service civilian opportunities, such as postsecondary education and increased earnings, among Black Veterans 7–10 . Military service may also have a “knifing‐off” effect of previous experience and disadvantage (i.e., the ability to limit the effects of early negative life events that would otherwise diminish downstream opportunities for advancement) 7,11 .…”

Section: Introductionmentioning

confidence: 99%

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Racial inequality in functional trajectories between Black and White U.S. veterans

Jacobs

Bowling

Brown

et al. 2022

J American Geriatrics Society

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Background Racial inequality in functional trajectories has been well documented in the U.S. civilian population but has not been explored among Veterans. Our objectives were to: (1) assess how functional trajectories differed for Black and White Veterans aged ≥50 and (2) explore how socioeconomic, psychosocial, and health‐related factors altered the relationship between race and function. Methods We conducted a prospective, longitudinal analysis using the 2006–2016 Health and Retirement Study. The study cohort included 3700 Veterans who self‐identified as Black or White, responded to baseline psychosocial questionnaires, and were community‐dwelling on first observation. We used stepwise and stratified linear mixed effects models of biannually assessed functional limitations. The outcome measure was as a count of functional limitations. Race was measured as respondent self‐identification as Black or White. Demographic measures included gender and age. Socioeconomic resources included partnership status, education, income, and wealth. Psychosocial stressors included exposure to day‐to‐day and major discrimination, traumatic life events, stressful life events, and financial strain. Health measures included chronic and mental health diagnoses, smoking, rurality, and use of Veterans Affairs services. Results Black Veterans developed functional limitations at earlier ages and experienced faster functional decline than White Veterans between the ages of 50 and 70, with convergence occurring at age 85. Once we accounted for economic resources and psychosocial stressors in multivariable analyses, the association between race and the number of functional limitations was no longer statistically significant. Lower wealth, greater financial strain, and traumatic life events were significantly associated with functional decline. Conclusions Health systems should consider how to track Veterans' function earlier in the life course to ensure that Black Veterans are able to get timely access to services that may slow premature functional decline. Providers may benefit from training about the role of economic resources and psychosocial stressors in physical health outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Racial inequality in functional trajectories between Black and White U.S. veterans

Jacobs

Bowling

Brown

et al. 2022

J American Geriatrics Society

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Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021

Krishnamurthy,

Li,

Sileanu

et al. 2024

J GEN INTERN MED

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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. Design 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. Participants Respondents to the 2016–2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey. Measures Care ratings in nine domains. Key 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.

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A Mixed Methods Study of the Association of Non-Veterans Affairs Care With Veterans’ and Clinicians’ Experiences of Care Coordination

et al. 2020

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Background: Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans’ access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. Objective: The objective of this study was to determine VA patients’ and clinicians’ experiences of coordination across VA and non-VA settings. Design: Observational mixed methods using patient surveys and clinician interviews. Sampled patients were diagnosed with type 2 diabetes mellitus and either cardiovascular or mental health comorbidities. Participants and Measures: Patient perspectives on coordination were elicited between April and September 2016 through a national survey supplemented with VA administrative records (N=5372). Coordination was measured with the 8-dimension Patient Perceptions of Integrated Care survey. Receipt of non-VA care was measured through patient self-report. Clinician perspectives were elicited through individual interviews (N=100) between May and October 2017. Results: Veterans who received both VA and non-VA care reported significantly worse care coordination experiences than Veterans who only receive care in VA. Clinicians report limited information exchange capabilities, which, combined with bureaucratic and opaque procedures, adversely impact clinical decision-making. Conclusions: VA is working through a shift in how Veterans receive health care by increasing access to care from non-VA providers. Study findings suggest that VA should prioritize coordination of care in addition to access. This could include requiring monitoring of patient-experienced care coordination, surveys of referring and consulting clinicians, and pilot testing and evaluation of interventions to improve coordination.

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Racial and Ethnic Differences in Satisfaction with Care Coordination Among VA and non-VA Medicare Beneficiaries

Cited by 3 publications

References 46 publications

Racial inequality in functional trajectories between Black and White U.S. veterans

Racial inequality in functional trajectories between Black and White U.S. veterans

Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021

A Mixed Methods Study of the Association of Non-Veterans Affairs Care With Veterans’ and Clinicians’ Experiences of Care Coordination

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