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2019 HSR&D/QUERI National Conference Abstract

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1048 — National Media Coverage and Health System Distrust in the Department of Veterans Affairs

Lead/Presenter: Audrey Jones,  COIN - Salt Lake City
All Authors: Jones AL (VA Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City), Fine MJ (Center for Health Equity Research and Promotion, Pittsburgh), Hausmann LRM (Center for Health Equity Research and Promotion, Pittsburgh) Stone R (Center for Health Equity Research and Promotion, Pittsburgh) Burkitt KH (Center for Health Equity Research and Promotion, Pittsburgh) Taber PA (VA Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City) Gao S (Center for Health Equity Research and Promotion, Pittsburgh) Zickmund, SL (VA Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City)

Objectives:
On 4/23/2014, national media outlets widely broadcast reports of excessive wait times and secret wait lists at several Veterans Affairs Medical Centers (VAMCs) across the country. Our aim was to examine changes in Veteran distrust in the VA health care system before and after the media coverage, and to explore whether changes in distrust over time varied by gender or race/ethnicity.

Methods:
Gender-stratified samples of Black, White, and Hispanic Veterans from 25 minority-serving VAMCs completed semi-structured telephone interviews between June 2013 and January 2015 as participants in the VA Disparities in Health Care Satisfaction (DISC) study. DISC interviews included the validated 9-item Health System Distrust (HSD) scale, ranging from 1(low) to 5 (high distrust). We used linear splines with knots at 90-day intervals to assess changes in HSD before and after 4/23/2014 ("day 0") by gender and race/ethnicity in a linear mixed model with a random effect for site.

Results:
Of 1,175 participants, 407 (34.6%) were non-Hispanic White, 382 (32.5%) non-Hispanic Black, and 386 (32.9%) Hispanic VA outpatients; 600 (51.1%) were women. Preliminary graphs of HSD over time revealed unique patterns for women versus men. Among women, time trends in distrust were flat before 4/23/2014 (p-value's > 0.05), increased 0.005 per day from days 0-90 (p < 0.01) and decreased -0.005 per day from days 90-180 post-coverage (p < 0.01) to pre-coverage levels. Among men, time trends were flat, except for a borderline significant uptick of 0.002 per day from days 0-90 (p = 0.059). Although levels of distrust were 0.20 to 0.25 points higher for Veterans of color compared to Whites, changes in distrust did not vary significantly by race/ethnicity over time.

Implications:
Distrust in the VA health care system increased in the 90 days following media coverage of wait times. This increase was greater for women than for men, and abated over the subsequent months.

Impacts:
While our analysis supports the hypothesis that negative media coverage regarding access and waitlists increased Veteran distrust in the VA, the impact was relatively limited in time and mainly observed among women. Higher distrust amongst Black and Hispanic Veterans, independent of the media coverage, points to areas for the VA to address.