Health Disparities in Veterans A Map of the Evidence
Health Disparities in Veterans A Map of the Evidence
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DOI：
10.1097/mlr.0000000000000756
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发表时间：
2017-09-01
期刊：
影响因子：
3
通讯作者：
Kansagara, Devan
中科院分区：
文献类型：
--
作者：
Kondo, Karli;Low, Allison;Kansagara, Devan
背景资料：在退伍军人健康管理局的卓越蓝图中概述了提高所有退伍军人的医疗质量和消除健康差距的目标，但在利用率，健康结果和医疗质量影响退伍军人的差异程度还没有得到很好的理解。目的：通过证据地图来描述退伍军人健康管理局医疗保健差异研究的特征。我们对2006年至2016年2月在MEDLINE和其他数据源中发表的研究进行了系统检索。我们纳入了退伍军人群体的研究，研究在3个结果类别的差距：利用，医疗保健的质量，和patient health.Measures：我们抽象的研究设计，设置，人口，临床领域，结果，介质，并存在差异，为每个结果类别的数据。我们按人口特征对数据进行分组，包括种族、残疾状况、精神疾病、人口统计学（年龄、服务年限、农村位置和距离护理）、性别认同、社会经济地位和无家可归者，并创建了说明证据的地图。结果：我们回顾了4249篇引文，并从351篇符合纳入标准的研究中提取了数据。迄今为止，绝大多数文献都是按种族/族裔审查差异的研究，其次是按性别和心理健康状况审查差异的研究。很少有研究探讨与女同性恋、男同性恋、双性恋或变性者身份或无家可归有关的差异。差异的调查结果有很大不同的人口和outcome.Conclusions：我们的证据地图提供了一个“奠定的土地”，并确定重要的差距，在知识的健康差异经历了不同的退伍军人群体。
Background: Goals for improving the quality of care for all Veterans and eliminating health disparities are outlined in the Veterans Health Administration Blueprint for Excellence, but the degree to which disparities in utilization, health outcomes, and quality of care affect Veterans is not well understood.Objectives: To characterize the research on health care disparities in the Veterans Health Administration by means of a map of the evidence.Research Design: We conducted a systematic search for research studies published from 2006 to February 2016 in MEDLINE and other data sources. We included studies of Veteran populations that examined disparities in 3 outcome categories: utilization, quality of health care, and patient health.Measures: We abstracted data on study design, setting, population, clinical area, outcomes, mediators, and presence of disparity for each outcome category. We grouped the data by population characteristics including race, disability status, mental illness, demographics (age, era of service, rural location, and distance from care), sex identity, socioeconomic status, and homelessness, and created maps illustrating the evidence.Results: We reviewed 4249 citations and abstracted data from 351 studies which met inclusion criteria. Studies examining disparities by race/ethnicity comprised by far the vast majority of the literature, followed by studies examining disparities by sex, and mental health condition. Very few studies examined disparities related to lesbian, gay, bisexual, or transgender identity or homelessness. Disparities findings vary widely by population and outcome.Conclusions: Our evidence maps provide a "lay of the land" and identify important gaps in knowledge about health disparities experienced by different Veteran populations.