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The objective of this evidence brief is to update the findings of previous ESP reviews on the prevalence of and interventions for reducing racial and ethnic disparities within the VA. The ESP CC investigators and representatives of the OHE worked together to identify the population, comparator, outcome, timing, setting, and study design characteristics of interest. The OHE approved the following key questions and eligibility criteria to guide this review:
Key Question #1: In which clinical areas are racial and ethnic disparities prevalent within the VA?
Key Question 1 inclusion criteria:
Population: Any VA population belonging to a racial or ethnic minority group
Intervention: N/A
Comparison: Minority versus non-minority Veterans
Outcomes: Mortality, morbidity, process measures (ie, offer and uptake of care, guideline adherence, etc), access (eg, wait times)
Timing: No restrictions
Setting: VA
Study design: Using a best evidence approach, we will prioritize evidence from systematic reviews and multisite studies that adequately controlled for potential patient-, provider-, and system-level confounding factors. Inferior study designs (eg, single-site, inadequate control for confounding) will only be accepted for particular racial or ethnic minority groups that lack adequate data from preferred study designs.
Key Question #2: What are the effects of interventions implemented within the VA to reduce racial and ethnic disparities?
Key Question 2 inclusion criteria:
Population: Any VA population belonging to a racial or ethnic minority group
Intervention: Any intervention primarily designed to reduce disparities or improve quality of care or outcomes for minority populations
Comparison: Head-to-head comparisons of different interventions, comparisons of intervention to usual care, comparison of same intervention in different racial or ethnic groups or in VA versus non-VA population
Outcomes: No restrictions
Timing: No restrictions
Setting: VA
Study design: Systematic reviews, controlled studies, interrupted time series, repeated measures studies
Peterson K, Anderson J, Boundy E, Ferguson L, McCleery E, Waldrip K. Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map. American Journal of Public Health. 2018;108(3):e1-e11. doi: 10.2105/AJPH.2017.304246
