Medical Care Supplement Features Articles by VA Researchers on Improving the Quality and Equity of Health and Healthcare
BACKGROUND:Bhalla and colleagues compared demographic characteristics, medical and psychiatric comorbidities, and healthcare use in 472,642 Veterans with single and poly-substance use disorder (PSUD). They found that Veterans with PSUD were more likely to be African American and homeless – and to have significantly greater medical and psychiatric comorbidity and use of mental healthcare services than Veterans with a single SUD diagnosis. The authors suggest that the distinctive clinical profile of PSUD warrants the development and evaluation of improved treatment models for patients with complex multi-morbid disorders.
Brignone and colleagues examined the association between military sexual trauma (MST) and healthcare use and costs – and how they vary by sex – in a cohort of 485,884 OEF/OIF Veterans receiving VA healthcare. They found that a positive MST screen was associated with significantly greater healthcare use and costs overall, and that after accounting for MST-related care, male Veterans had nearly twice the healthcare encounters and costs of female Veterans. The authors concluded that although the overall effect of a positive MST screen is similar for men and women, treatment is more often designated as MST-related among women.
Lehavot and colleagues conducted a national survey of 298 transgender Veterans to examine their satisfaction with VA medical and mental healthcare, the prevalence of delaying care, and correlates of these outcomes. They found that while most of the respondents who used VA healthcare were satisfied with their medical and mental healthcare, low income was associated with dissatisfaction with medical care – and being a transgender man was associated with dissatisfaction with mental healthcare. The authors suggest that efforts to better engage certain subgroups of transgender Veterans in VA healthcare may be necessary.
Gundlapalli and colleagues assessed the impact of a patient-aligned care team tailored for homeless Veterans (H-PACT) on emergency department (ED) utilization. Compared to usual care, H-PACT enrollees had a significant decrease in ED use among the highest ED utilizers. The authors concluded that primary care treatment engagement for homeless Veterans should reduce the frequency of ED visits.
VA supports a number of organizational, clinical, and research initiatives explicitly focused on advancing health equity for Veterans. For example, in 2012 VA established the Office of Health Equity (OHE) to champion the advancement of health equity and reduction of health disparities in the VA healthcare system. Despite these efforts, disparities in care persist. Given this ongoing challenge, HSR&D's Center for Health Equity Research and Promotion (CHERP) and the Health Equity and Rural Outreach Innovation Center (HEROIC) hosted a state-of-the-science conference in 2016. This field-based meeting to "Engage Diverse Stakeholders and Operational Partners in Advancing Health Equity in the VA Healthcare System" brought together health equity investigators, representatives of vulnerable Veteran populations, and operational leaders to identify strategies to advance the implementation of evidence-based interventions to improve the quality and equity of health and healthcare. The conference focused on three specific vulnerable Veteran populations: racial and ethnic minorities, homeless Veterans, and Veterans from the LGBT community. This supplement features several articles that emanated from this meeting, including but not limited to:
Medical Care Supplement: Health Equity. September 2017;55(9, Suppl 2);S1-120.