Racial Disparities Persist in VA Health System

Despite efforts to improve the quality of care in the Department of Veterans Affairs health system, racial disparities remain for certain conditions, according to a study published in the April issue of Health Affairs .

Clinical outcomes for glucose control, low-density lipoprotein control, and blood pressure showed the greatest degree of disparity between black and white veterans. Researchers based their findings on quality data from the VA’s External Peer Review Program from 2000 to 2009. The study examined disparities following a major reorganization of the VA health system and a push for quality improvement in the late 1990s.

The results highlight the need for the VA to routinely track clinical outcomes for vulnerable groups, Dr. Amal Trivedi, the study’s lead author, said in an interview.

"Even in a system that’s achieved really significant quality gains, there are still disparities that need to be addressed," said Dr. Trivedi, a research investigator at the Providence VA Medical Center and an assistant professor of community health at Brown University in Providence, R.I.

One of the most surprising findings, according to the researchers, was that the disparities weren’t a result of black veterans receiving care at lower-quality facilities. Instead, the greatest differences in care were noted when black and white veterans were treated in the same hospital.

In the study, researchers measured performance indicators for 1,126,254 veterans (955,047 white; 171,207 black). Researchers also compared clinical outcomes to process-of-care indicators such as screening measures (Health Aff. 2011;30:707-15). Patients were separated on the basis of sex, age, census region, and socioeconomic status.

Black veterans, on average, were younger, less educated, of low socioeconomic status, and from the Southern region. With the exception of mammography, performance rates notably improved for both racial groups. However, clinical outcomes for black veterans lagged behind those for white veterans in a few areas. For example, on measures of cardiovascular care, there was an 8.3% difference between outcomes for white veterans and black veterans on LDL control. Under the diabetes care measures, there was a 5.8% difference in HbA_1c control and a 6.8% difference in LDL control between blacks and whites. Under the hypertension measure, there was a 5.8% difference in blood pressure control.

These findings are consistent with the results of previous studies showing racial disparities in glucose, blood pressure, and cholesterol control, according to Dr. Trivedi. These findings are a cry for consistency of care and standardized treatment protocols, the researchers said.

The study results were limited to VA services only. The researchers did not assess possible disparities among other ethnicities or examine the impact of other possible contributing factors, such as lifestyle modifications or comorbid medical conditions.

The research was funded in part by the Department of Veterans Affairs and the Robert Wood Johnson Foundation.

Despite efforts to improve the quality of care in the Department of Veterans Affairs health system, racial disparities remain for certain conditions, according to a study published in the April issue of Health Affairs .

Clinical outcomes for glucose control, low-density lipoprotein control, and blood pressure showed the greatest degree of disparity between black and white veterans. Researchers based their findings on quality data from the VA’s External Peer Review Program from 2000 to 2009. The study examined disparities following a major reorganization of the VA health system and a push for quality improvement in the late 1990s.

The results highlight the need for the VA to routinely track clinical outcomes for vulnerable groups, Dr. Amal Trivedi, the study’s lead author, said in an interview.

"Even in a system that’s achieved really significant quality gains, there are still disparities that need to be addressed," said Dr. Trivedi, a research investigator at the Providence VA Medical Center and an assistant professor of community health at Brown University in Providence, R.I.

One of the most surprising findings, according to the researchers, was that the disparities weren’t a result of black veterans receiving care at lower-quality facilities. Instead, the greatest differences in care were noted when black and white veterans were treated in the same hospital.

In the study, researchers measured performance indicators for 1,126,254 veterans (955,047 white; 171,207 black). Researchers also compared clinical outcomes to process-of-care indicators such as screening measures (Health Aff. 2011;30:707-15). Patients were separated on the basis of sex, age, census region, and socioeconomic status.

Black veterans, on average, were younger, less educated, of low socioeconomic status, and from the Southern region. With the exception of mammography, performance rates notably improved for both racial groups. However, clinical outcomes for black veterans lagged behind those for white veterans in a few areas. For example, on measures of cardiovascular care, there was an 8.3% difference between outcomes for white veterans and black veterans on LDL control. Under the diabetes care measures, there was a 5.8% difference in HbA_1c control and a 6.8% difference in LDL control between blacks and whites. Under the hypertension measure, there was a 5.8% difference in blood pressure control.

These findings are consistent with the results of previous studies showing racial disparities in glucose, blood pressure, and cholesterol control, according to Dr. Trivedi. These findings are a cry for consistency of care and standardized treatment protocols, the researchers said.

The study results were limited to VA services only. The researchers did not assess possible disparities among other ethnicities or examine the impact of other possible contributing factors, such as lifestyle modifications or comorbid medical conditions.

The research was funded in part by the Department of Veterans Affairs and the Robert Wood Johnson Foundation.

Despite efforts to improve the quality of care in the Department of Veterans Affairs health system, racial disparities remain for certain conditions, according to a study published in the April issue of Health Affairs .

Clinical outcomes for glucose control, low-density lipoprotein control, and blood pressure showed the greatest degree of disparity between black and white veterans. Researchers based their findings on quality data from the VA’s External Peer Review Program from 2000 to 2009. The study examined disparities following a major reorganization of the VA health system and a push for quality improvement in the late 1990s.

The results highlight the need for the VA to routinely track clinical outcomes for vulnerable groups, Dr. Amal Trivedi, the study’s lead author, said in an interview.

"Even in a system that’s achieved really significant quality gains, there are still disparities that need to be addressed," said Dr. Trivedi, a research investigator at the Providence VA Medical Center and an assistant professor of community health at Brown University in Providence, R.I.

One of the most surprising findings, according to the researchers, was that the disparities weren’t a result of black veterans receiving care at lower-quality facilities. Instead, the greatest differences in care were noted when black and white veterans were treated in the same hospital.

In the study, researchers measured performance indicators for 1,126,254 veterans (955,047 white; 171,207 black). Researchers also compared clinical outcomes to process-of-care indicators such as screening measures (Health Aff. 2011;30:707-15). Patients were separated on the basis of sex, age, census region, and socioeconomic status.

Black veterans, on average, were younger, less educated, of low socioeconomic status, and from the Southern region. With the exception of mammography, performance rates notably improved for both racial groups. However, clinical outcomes for black veterans lagged behind those for white veterans in a few areas. For example, on measures of cardiovascular care, there was an 8.3% difference between outcomes for white veterans and black veterans on LDL control. Under the diabetes care measures, there was a 5.8% difference in HbA_1c control and a 6.8% difference in LDL control between blacks and whites. Under the hypertension measure, there was a 5.8% difference in blood pressure control.

These findings are consistent with the results of previous studies showing racial disparities in glucose, blood pressure, and cholesterol control, according to Dr. Trivedi. These findings are a cry for consistency of care and standardized treatment protocols, the researchers said.

The study results were limited to VA services only. The researchers did not assess possible disparities among other ethnicities or examine the impact of other possible contributing factors, such as lifestyle modifications or comorbid medical conditions.

The research was funded in part by the Department of Veterans Affairs and the Robert Wood Johnson Foundation.