Zickmund SL (VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion (CHERP)), Burkitt KH
(CHERP), Rodriguez KL
(CHERP), Switzer G
(CHERP), Stone RA
(CHERP), McClenney LW
(Center for Minority Veterans), Powell CT
(Center for Minority Veterans), Newsome ES
(Center for Minority Veterans), Allen R
(Center for Minority Veterans), Fine MJ
In June 2008, VA released its Hospital Report Card which revealed racial disparities in veteran satisfaction with care. In response to a Congressional inquiry, the Secretary for Veterans Affairs commissioned the national Center for Minority Veterans and the Center for Health Equity Research and Promotion (CHERP) to rapidly obtain in-depth veteran input with the goal of advancing our understanding of this disparity in VA care.
Six hundred veterans from three urban VA medical centers with an equal distribution of African Americans (AA) and Caucasians (CA), as well as those with a recent inpatient/outpatient visit, were identified as potential interview participants. Likert scale outcomes included satisfaction with overall VA care, outpatient care, inpatient care, and trust in providers. Qualitative questions included satisfaction with access, respect, and pain management. Two trained interviewers completed and audiotaped all interviews. Fisher's exact tests were used for discrete and ANOVA for continuous variables. Likert scales were analyzed using ordinal logistic or multinomial regression to detect differences by race. A qualitative expert and a trained analyst coded all interviews using an iteratively developed codebook; the intercoder reliability kappa score was 0.99.
Seventy-eight veterans were contacted by telephone; 60 (77%) completed the interview (20/site). The participants were married (54%), retired/disabled (48%), and in self-reported good health (42%). AAs were younger (P < 0.01), better educated (P = 0.05), and in poorer health (P = 0.07). Adjusting for site, CAs reported higher satisfaction with overall VA care (77.4% vs. 51.7%; P = 0.07) and with outpatient care (86.7% vs. 65.4%; P = 0.02); no racial differences existed for inpatient care. AAs reported less trust in their medical providers (67.9% vs. 90.3%; P = 0.05). Qualitative analysis revealed reasons for AA dissatisfaction, including: access to care (difficulties navigating the VA system), feelings of disrespect by staff, and poor pain management (accusations of selling narcotics).
We found significant racial disparities in satisfaction with overall VA and outpatient care. Trust in physicians, staff respect, access to care, and pain management were described by AAs as contributing to this dissatisfaction.
The VA is committed to high quality care and high satisfaction for all veterans. Future interventions are needed to reduce and eliminate this important disparity.