Racial and Ethnic Disparities in Satisfaction with VA Care

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DESCRIPTION (provided by applicant): Project Background: Patient satisfaction is a widely accepted measure of the effectiveness of providers and healthcare systems. It is also a Veterans Administration (VA) mission-critical performance measure. Patient satisfaction is linked to improved health behaviors and outcomes. Unfortunately, patient satisfaction for minority Veterans is lower in the VA than it is for whites. Understanding reasons why minority Veterans report decreased satisfaction with care is necessary in order to ameliorate this disparity. Project Objectives: The Specific Aims of this study are: Specific Aim 1. To examine the associations between patient race/ethnicity and satisfaction with overall, outpatient, inpatient, and 12 domains of VA health care based on a quantitative survey. Specific Aim 2. To identify themes of satisfaction and dissatisfaction with overall, outpatient, inpatient, and 12 domains of VA health care in a diverse sample of African Americans, Hispanics, and whites based on a qualitative interview. Specific Aim 3: To use mixed methods to examine differences in themes of satisfaction and dissatisfaction with overall, outpatient, inpatient, and 12 domains of VA health care among African Americans, Hispanics, and whites. Project Methods: Using a random sample drawn from 25 VA Medical Centers, we will conduct telephone interviews from the VA Pittsburgh Healthcare System using both closed and open- ended questions with 750 African American, Hispanic, and white Veterans as well as a small sample of other minority Veterans (Asian, Pacific Islander/Native Hawaiian, or American Indian/Native Alaskan). This mixed-methods design allows for the examination of the direct, mediated and/or moderated associations of race/ethnicity on satisfaction outcomes. The open- ended questions will provide data for a formal qualitative analysis of both reasons for satisfaction and dissatisfaction with VA health care and ways to improve VA care that are culturally sensitive. Finally, random effects modeling of coded qualitative data will be used to formally estimate and test racial/ethnic differences. Because the random effects modeling uses open-ended, qualitative data this statistical analysis allows our study to go beyond reliance on pre-established satisfaction items, and instead capture very specific reasons for satisfaction and dissatisfaction with VA health care as described by the Veterans themselves.