Understanding Racial and Ethnic Differences in Patient Experiences With Outpatient Health Care in Veterans Affairs Medical Centers
Understanding Racial and Ethnic Differences in Patient Experiences With Outpatient Health Care in Veterans Affairs Medical Centers
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DOI：
10.1097/mlr.0b013e318287d6e5
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发表时间：
2013-06-01
期刊：
影响因子：
3
通讯作者：
Fine, Michael J.
中科院分区：
文献类型：
--
作者：
Hausmann, Leslie R. M.;Gao, Shasha;Fine, Michael J.
背景资料：在退伍军人事务部（VA）Healthcare System.Objectives中，患者医疗保健经历中的种族和民族差异尚未得到很好的研究：研究VA医疗机构内部和之间门诊医疗保健经历中的种族/民族差异。我们评估了机构内和机构间的种族/民族差异，以回应2010年VA调查的医疗保健经验的患者使用混合-影响多项回归。主题：共211，459名受访者（53.2%）的门诊病人从910 VA医疗设施的随机调查（71.9%为非西班牙裔白色人，15.1%为非西班牙裔黑人，6.4%为西班牙裔人，6.7%为其他种族/族裔）。消极和积极的病人报告的经验，在8个领域的卫生保健。结果：设施间的影响，黑人种族较高的7个领域的消极经验[风险差异（RD）：积极体验的6个领域的RDs较低（RDs：-0.69%至2.54%）。西班牙裔的机构间效应在5个负面体验领域较高（RD：0.60%-1.34%），在5个正面体验领域较低（RD：-1.00%至-1.88%）。西班牙裔也与5个护理领域的机构内积极体验率较高相关（RD：2.97%-4.08%）。其他人种/种族与机构内不良经历发生率显著较高相关（RD：2.04%-3.95%），所有8个领域的积极体验率较低（RDs：-2.05% to -4.70%）。在VA医疗保健系统管理的退伍军人的全国随机样本中，我们证明了在门诊医疗保健经历中，机构内和机构间的种族和民族差异显著，每个少数群体的模式不同。
Background: Racial and ethnic differences in patient health care experiences have not been well examined in the Veterans Affairs (VA) Healthcare System.Objectives: To examine racial/ethnic differences in outpatient health care experiences within and between VA medical facilities.Research Design: We assessed within-facility and between-facility racial/ethnic differences in responses to the 2010 VA Survey of Healthcare Experiences of Patients using mixed-effects multinomial regression.Subjects: A total of 211,459 respondents (53.2%) to a random survey of outpatients from 910 VA medical facilities (71.9% non-Hispanic white, 15.1% non-Hispanic black, 6.4% Hispanic, and 6.7% Other race/ethnicity).Measures: Negative and positive patient-reported experiences in 8 domains of health care.Results: Between-facility effects for black race were higher for 7 domains of negative experiences [risk differences (RDs): 0.37% to 1.64%] and lower for 6 domains of positive experiences (RDs: -0.69% to -2.54%). Between-facility effects for Hispanic ethnicity were higher for 5 domains of negative experiences (RDs: 0.60%-1.34%) and lower for 5 domains of positive experiences (RDs: -1.00% to -1.88%). Hispanic ethnicity was also associated with higher within-facility rates of positive experiences for 5 domains of care (RDs: 2.97%-4.08%). Other race/ethnicity was associated with significantly higher within-facility rates of negative experiences (RDs: 2.04%-3.95%) and lower rates of positive experiences for all 8 domains (RDs: -2.05% to -4.70%).Conclusions: In a national random sample of Veterans managed in the VA Healthcare System, we demonstrated significant within-facility and between-facility racial and ethnic differences in outpatient health care experiences, with differing patterns for each minority group.