Veterans Health Administration Patient Experience at the Intersection of Gender and Race-Ethnicity: Special Report from the National Veteran Health Equity Report

Breland JY, Toyama JA, Yuan A, Steers WN, Beckman K, Nestman K, Jackson L, Kasom DR, Canning M, Washington DL. Veterans Health Administration Patient Experience at the Intersection of Gender and Race-Ethnicity: Special Report from the National Veteran Health Equity Report. Focus on Veterans Health Administration Patient Experience and Health Care Quality. Washington, DC: VHA Office of Health Equity; 2024 Aug 1. 39 p.

The National Veterans Health Equity Report (NVHER) was released in 2021 and provides information on disparities in patient experiences and health care quality for Veterans who obtain health care services through the Veterans Health Administration (VHA).1 The NVHER presents this information across demographic groups, including race, ethnicity, gender, age group, rurality of residence, socio-economic status, and service-connected disability rating. Additionally, the NVHER uses this information to identify disparities among Veterans with cardiovascular risk factors, focusing on hypertension, hyperlipidemia, and diabetes. The NVHER's unique national cross-sectional analysis provides a snapshot of disparities that are experienced by patients in a clear way for VHA providers and leaders to identify and address. This National Veterans Health Equity Report special report was designed with a similar framework in mind, focusing on the experiences of care for women Veterans by race and ethnicity. The data in this report are from the fiscal year (FY) 2016 to fiscal year 2019 Department of Veteran Affairs (VA) Survey of Healthcare Experiences of Patients (SHEP) Patient Centered Medical Home survey instrument, which assesses three domains across 28 items (See the Appendix for a list of all included items). 1) The first domain, Access, assesses patients' ability to get timely appointments, care, and information (e.g., In the last 6 months, when you contacted this provider's office to get an appointment for care you needed right away, how often did you get an appointment as soon as you needed?). 2) The second domain, Person-Centered Care, focuses on how well care is tailored to patients' needs. It includes measures of: a) Communication (e.g., In the last 6 months, how often did this provider give you easy to understand information about these health questions or concerns?), b) Comprehensiveness in paying attention to patients' mental health (e.g., In the last 6 months, did anyone in this provider's office ask you if there was a period of time when you felt sad, empty or depressed?), and c) Self-management support (e.g., In the last 6 months, did anyone in this provider's office talk with you about specific goals for your health?). 3) The third domain, Care Coordination, provides information related to the coordination of patient care (e.g., In the last 6 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider's office follow up to give you those results?). Building on the NVHER, the goal of this special report is to provide VHA leaders, providers, and staff with information to address disparities identified with an intersectional approach,2 that takes into consideration how Veteran's intersecting identities related to gender, race, and ethnicity result in unique experiences with marginalization. Following American Medical Association guidelines, this report uses the term "minoritized racial and ethnic groups" to acknowledge the influence of structural inequalities in health disparities, rather than using terms like "minority" or "minorities," which can be stigmatizing.3 The data in this report are from FY16-FY19. Hence, they precede recent initiatives to improve care for women and racial and ethnic minoritized Veterans. These initiatives include the full implementation of maternity care coordinators, provision of reproductive mental health services, and breastfeeding/chest feeding support through lactation consultants However, these data provide a critical baseline against which to track the health care experiences of racial and ethnic minoritized women Veterans. 1 Women currently make up about 11% of Veterans (FY23) and are the fastest growing subpopulation of Veterans.4 In the year 2000 they comprised 4% of all Veterans and are projected to make up 18% of all Veterans by 2040.4 Additionally, women Veterans have increased in racial and ethnic diversity over time, and this trend is projected to continue in the future (Exhibit 1).5 Women Veterans are also more racially and ethnically diverse than men Veterans, with 43% of women Veterans who used VA healthcare in 2020 belonging to a minoritized racial or ethnic group compared with 25% of Veterans as a whole.4,6 Given the increasingly diverse nature of the women Veteran population, this special report offers VHA an opportunity to continue to address existing disparities and eliminate future disparities for women Veterans of color. VHA has already taken numerous steps to improve care and experiences for women Veterans. Key programs include on-site Women Veteran Program Managers and Women's Health Medical Directors, who are responsible for ensuring high quality care for women Veterans,7 specially trained or experienced women's health primary care providers and patient aligned care teams, mini-residency programs in women's health for VHA physicians and staff, Maternity Care Coordinators at every site, state of the art IT projects to support breast and cervical cancer screening, and more.8 Additionally, the Women's Health Evaluation Initiative was established to provide actionable information on key aspects of women Veterans' health and health care.9 Given these demographic and programmatic shifts, this special report assesses women Veterans' experiences of VHA care by race and ethnicity and compares those metrics to those of men Veterans from corresponding racial and ethnic groups. This special report also describes comparisons of VHA care experiences between racial and ethnic minoritized women Veterans and both non-Hispanic White women and men Veterans. This methodology allows VHA to explore ways to improve care experiences for all Veterans, regardless of sex, race, or ethnicity.