Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes
Despite Improved Quality Of Care In The Veterans Affairs Health System, Racial Disparity Persists For Important Clinical Outcomes
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DOI：
10.1377/hlthaff.2011.0074
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发表时间：
2011-04-01
期刊：
影响因子：
9.7
通讯作者：
Washington, Donna L.
中科院分区：
文献类型：
--
作者：
Trivedi, Amal N.;Grebla, Regina C.;Washington, Donna L.
政府和私营医疗保健系统都在努力提高质量，但这些举措对种族和民族差异的影响尚未得到充分研究。在组织转型后的十年中，退伍军人事务部（VA）医疗保健系统在护理质量方面取得了实质性的改善，大多数护理过程措施（如胆固醇筛查率）的种族差异最小。然而，在我们的研究中，我们观察到广泛使用的过程测量的高水平性能与临床结果的适度改善（如血压，血糖和胆固醇水平的控制）之间存在显著的脱节。我们还观察到非裔美国退伍军人和白色退伍军人之间的临床结果差距高达9个百分点。几乎所有的结果在VA的差异解释了设施内的差异，这表明VA医疗中心需要衡量和解决种族差距，在照顾他们的病人群体。此外，由于心血管疾病和糖尿病是预期寿命种族差异的主要因素，本研究和其他研究的结果强调了集中努力改善VA和其他环境中非洲裔美国人中间结果的紧迫性。
Both government and private health care systems have engaged in efforts to improve quality, but the effect of these initiatives on racial and ethnic disparities has not been well studied. In the decade following an organizational transformation, the Veterans Affairs (VA) health care system achieved substantial improvements in quality of care with minimal racial disparities for most process-of-care measures, such as rates of cholesterol screenings. However, in our study we observed a striking disconnect between high levels of performance on widely used process measures and modest levels of improvement in clinical outcomes, such as control of blood pressure, blood glucose, and cholesterol levels. We also observed a gap in clinical outcomes of as much as nine percentage points between African American veterans and white veterans. Almost all of the disparity in outcomes in the VA was explained by within-facility disparity, which suggests that VA medical centers need to measure and address racial gaps in care for their patient populations. Moreover, because cardiovascular disease and diabetes are major contributors to racial disparities in life expectancy, the findings of this study and others underscore the urgency of focused efforts to improve intermediate outcomes among African Americans in the VA and other settings.