Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1040 — Racial/Ethnic Disparities in Intermediate Clinical Outcomes Four Years Into VA Implementation of Patient-Aligned Care Teams

Lead/Presenter: Donna Washington, COIN - Los Angeles
All Authors: Washington DL (Office of Health Equity (OHE)-QUERI PEI; VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles; UCLA) Huynh AK (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles; Office of Health Equity (OHE)-QUERI PEI) Steers WN (OHE-QUERI PEI; VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles; UCLA ) Riopelle D (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles; OHE-QUERI PEI) Yano EM (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles; OHE-QUERI PEI; UCLA) Frayne SM (VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; Stanford University School of Medicine; OHE-QUERI PEI) Saechao FS (VA HSR&D Center for Innovation to Implementation, VA Palo Alto Health Care System; OHE-QUERI PEI ) Uchendu US (Office of Health Equity, Veterans Health Administration) Hoggatt KJ (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles; OHE-QUERI PEI; UCLA)

Objectives:
Hypertension and diabetes are risk factors for cardiovascular disease, the leading cause of death in the U.S. In VA, racial/ethnic disparities in hypertension and diabetes control have been identified. In 2010, VA began implementing Patient Aligned Care Teams (PACT). Early evaluation found higher PACT implementation was associated with more Veterans achieving both hypertension and diabetes control, however, it is unknown if these benefits extend to all racial/ethnic groups. Our objective was to determine if national racial/ethnic disparities in hypertension and diabetes control were mitigated concurrent with PACT implementation.

Methods:
Using 2009 and 2014 External Peer Review Program data from VA Office of Analytics and Business Intelligence, we fit linear probability models with binomial error distributions for hypertension control (blood pressure < 140/90 in Veterans with hypertension; n = 146,698) and diabetes control (glycosylated hemoglobin < = 9 in Veterans with diabetes; n = 79,832), first adjusting for patient clustering by healthcare system, PACT implementation, primary care exposure, and demographic characteristics, then adding socio-economic status adjustment. For each racial/ethnic group and year, we calculated predicted probabilities of achieving each outcome, and computed differences between each group and Whites as estimates of single-year disparities, then tested for differences in race/ethnicity disparities between 2014 and 2009.

Results:
Pre-PACT implementation, disparities > = 5% in hypertension or diabetes control were present for most racial/ethnic groups compared with Whites. In 2014, hypertension disparities persisted for Blacks and narrowed for Hispanics; after accounting for socio-economic status, the disparity change for Hispanics was no longer statistically significant. By contrast, diabetes control worsened for several groups including Whites, leaving persistent disparities ( > = 5%) in 2014 for Blacks, Hispanics, and American Indian/Alaska Natives.

Implications:
Concurrent with VA's system-wide investment in PACT, racial/ethnic disparities in achieving hypertension and diabetes control changed across and within racial/ethnic groups, albeit inconsistently. Our findings demonstrate benefits of PACT may not necessarily extend equitably to all segments of the VA patient population.

Impacts:
Additional strategies are needed to further reduce racial/ethnic health disparities. PACT implementation may require tailored strategies that account for determinants of racial-ethnic variations. Consistently monitoring impact of initiatives and routinely tracking data on vulnerable Veteran groups will support on-going efforts to address healthcare disparities among Veterans.