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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

1040 — Quality of Care and Race in the VA

Author List:
Fleming BB (OQP VHACO)
Washington DL (LA HSR&D COE)

The quality of care in the Department of Veterans Affairs (VA) health care system is recognized as a benchmark of quality in many areas of healthcare. Studies examining racial variation in the VA are few and to date there has been no systematic study of quality of care in the VA as affected by race. The purpose of this study was to compare the quality of inpatient and outpatient care between African Americans (AA) and whites in the VA health care system using a well defined set of performance measures addressing disease prevention, common chronic conditions, and acute illness.

This is a retrospective cross-sectional study of the quality of care received by white and AA veterans obtaining care in the VA during fiscal year 2004 (October 1 to September 30). Data were obtained from the VA External Peer Review Program (N=88,965). We used quality measures of prevention, chronic disease management, and acute illness management. We identified race by linking EPRP data with several other data sources including national patient surveys previously conducted by OQP, and years of Medicare and VA administrative data files. Using multivariate logistic regression to adjust for age, sex, VA priority status, region, mental health diagnosis, and academic status of hospitals, we assessed whether race was independently associated with each quality measure.

The study population was composed of 83% white and 17% AA. After adjusting for covariates, 27 of 37 quality measures were not statistically different between whites and African Americans. Whites had higher adjusted rates (3% or greater) for pneumococcal and influenza screening, four diabetes, and two hypertension measures.

We found no differences between whites and AA for almost all measures which reflect an appropriate process of care. For some measures which reflect a desired intermediate outcome of care, we found that AA had significantly lower scores related to hypertension and diabetes control, and immunizations.

These data have important implications for VA quality improvement efforts. More research is needed to examine the influence of race on quality while accounting for other important clinical and socio-economic factors.

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