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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3124 — Racial Disparity in Veterans’ Satisfaction with Compensation and Pension Posttraumatic Stress Disorder Examinations

Rosen MI, VA Connecticut Healthcare; Afshartous DNwosu S, and Jackson J, Tennessee Valley Healthcare; Marx B, National Center for PTSD; Murdoch M, Minneapolis VA Medical Center; Scott M, VA Connecticut Healthcare; Speroff T, Tennessee Valley Healthcare;

Objectives:
In surveys, many Veterans indicate that their Compensation and Pension examinations for PTSD were conducted by examiners who did not understand them. Racial biases in awards for PTSD service-connection have also been described. Little is known about what racial or other factors are associated with Veterans’ perception the examination was done well.

Methods:
Data were drawn from 384 Veterans participating in a clinical trial comparing a structured disability interview to usual interviews. Immediately after the interview, 225 Caucasian and 97 African-American Veterans completed confidential ratings of the quality of the examination and of their examiners’ interpersonal qualities and competence. Regression analyses considered multiple independent variables and clustering within 38 clinical examiners and the six participating medical centers.

Results:
The overall examination quality was rated "excellent" by 47% of Caucasian Veterans and 34% of African American Veterans. In multivariate analyses, African American Veterans were less likely than Caucasians to assign a higher overall examination quality rating (odds ratio 0.61, 95% confidence interval .38, .99). In addition, African American Veterans, compared to Caucasians, rated their examiners as having significantly worse interpersonal qualities but not lower competence. Ratings were not significantly related to the Veterans' age, gender, marital status, ultimate diagnosis of PTSD, Global Assessment of Functioning score, the examiners’ perception of the prevalence of malingering, or the presence of a third party in the examination.

Implications:
African American Veterans rated their disability examinations less favorably compared to whites, particularly as related to overall examination quality and interpersonal qualities of their examiners.

Impacts:
Training targeting patient-provider interactions might improve African-American Veterans’ satisfaction with their Compensation and Pension examinations.


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