AJPH Supplement Highlights Equity Research on VA Healthcare

Even though VA is currently facing highly publicized challenges in ensuring timely access to healthcare for Veterans, studies document remarkable strides in the delivery of high-quality healthcare in the VA relative to the private sector. This progress is driven by VA's emphasis on patient-centered, proactive, personalized healthcare and its sustained commitment to the equitable delivery of high-quality healthcare to all Veterans, particularly vulnerable patient populations based on gender, geography (e.g., Veterans living in rural areas), racial/ethnic minorities, and/or physical and mental disability.

A newly published American Journal of Public Health (AJHP) Health Equity Supplement (open access) includes eight editorials, three briefs, and ten original articles that highlight health disparities research – conducted within the VA and with Veterans – and VA's commitment to continuous improvement in the delivery of quality healthcare for all Veterans. Each study also fits a widely used conceptual framework to advance the field of health equity research through three sequential generations: detecting disparities in health and/or healthcare (1^st generation), understanding the determinants of such disparities (2^nd generation), and reducing disparities (3^rd generation) [Kilbourne et al., 2006]. Following is a brief summary of findings from some of these exceptional articles.

• Blosnich and colleagues compared rates of suicidal ideation and attempts among lesbian, gay, bisexual (LGB), and heterosexual Veterans. Study findings show that although there were no significant differences in recent suicidal ideation and lifetime suicide attempts, LGB Veterans had higher odds of lifetime suicidal ideation than heterosexual Veterans. The authors conclude that suicide prevention efforts for LGB Veterans could benefit from a life course perspective regarding suicide risk.
• Backus and colleagues assessed hepatitis C virus (HCV) screening and prevalence among Veterans and estimated the potential impact of complete birth cohort screening. Study findings show that more than 5 million Veterans received HCV screening and that the prevalence of the virus was highest among African-Americans. Moreover, incident HCV infection was higher in male than female Veterans in 2012. The authors concluded that HCV prevalence is markedly elevated among Veterans born during 1945-1965, with substantial variation based on race and sex.
• Copeland and colleagues examined factors associated with suicidal behavior and ideation in more than 89,000 Veterans who underwent major surgery between 10/05 and 9/06. Study findings show that African-American Veterans were at increased risk of suicidal behavior and ideation, while Hispanic Veterans were not. Investigators also identified risk factors for suicidal behavior and ideation, including serious mental illness, pain disorders, post-operative new-onset depression, and post-operative complications. The authors suggest the post-operative period may be a time of heightened risk for suicidal behavior and ideation among high-risk Veterans.
• McInnis and colleagues examined the feasibility of sending mobile phone text appointment reminders to homeless Veterans to increase their engagement in VA healthcare. Study findings show that Veterans were generally highly satisfied with the text message reminders, had very few technical difficulties, and indicated a desire for it to continue. The intervention also reduced patient cancelations and no-shows, emergency room visits, and hospital admissions. The authors conclude that text messaging appears to be a feasible means of reaching homeless Veterans and may help improve the quality and equity of care for this highly vulnerable population.

The original research featured in this Supplement demonstrates the importance of continued 1^st and 2^nd generation studies to detect and understand disparities across a broad range of vulnerable Veteran populations, including racial and ethnic minorities, women, LBG, and the homeless.

Reference: American Journal of Public Health (AJPH) Health Equity Supplement. August 6, 2014.

Citation: Kilbourne K, Switzer G, Hyman K, et al. Advancing health disparities research within the health care system: A conceptual framework. American Journal of Public Health. 2006;96(12):2113-2121.

Additional resources: Please see a video about the AJPH Health Equity Supplement that features Robert Jesse, M.D., Ph.D., former Acting Under Secretary for Health, and Uchenna Uchendu, M.D., Executive Director, VA Office of Health Equity.

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This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.