QUERI-Office of Health Equity (OHE) Partnered Evaluation Center

背景/理由：健康差距是指健康结果及其决定因素的差异 由社会、人口、环境和地理属性定义的人口部分。 随着时间的推移，健康差距在美国持续存在，影响到弱势群体的各种疾病 人口。在退伍军人健康管理局(VHA)，接受护理的经济障碍是 差距缩小了，但在许多重要的健康结果中仍然存在。易受攻击 VHA内的人群包括那些因以下原因而面临身体、心理或社会健康不良风险的人 关于历史上与歧视或排斥有关的基本特征的差异。虽然范围很广 一系列研究考察了某些疾病和弱势群体在护理方面的差异和差距。 在人群中，还没有对诊断条件、死亡率或质量进行系统评估 整个VHA医疗保健用户群体，因此VHA健康和质量差距的程度 脆弱的退伍军人群体尚不清楚。 目标：QUERI-健康公平办公室合作评估中心有四个具体目标。它寻求： (1)评估易受攻击的VHA老用户群体和参考资料之间目前存在的差异 被认为是残疾的主要原因的主要疾病的发病率和死亡率的分组 死亡率，特别是在脆弱的退伍军人群体中；(2)检查护理质量方面的差距和趋势 跨脆弱退伍军人群体的治疗环境；(3)确定新的 护理模式改变了弱势人口状况与护理质量差距之间的联系；以及(4) 与VHA健康公平办公室合作，召开一个咨询委员会，审查 确定为减少已确定的差距而需要采取的下一步步骤，以便为行动的进展情况提供信息 计划减少VHA的健康差距。 方法：我们利用人口健康的方法来检查诊断出的健康的分布。 整个VHA资深用户群体的状况、死亡率和医疗质量，由其定义 在弱势群体中是否有成员资格。这些弱势群体的定义是：种族/民族， 性别、社会经济地位、居住乡村、与服务有关的残疾状况、严重精神疾病以及 年龄段。我们将使用VHA管理数据源的辅助数据分析，这些数据源建立在现有的 包含完整的VHA患者多年队列的数据库。 预期影响：认识到政策和干预措施改善健康结果的潜力 对于弱势群体，这个合作评估中心结合了旨在利用调查结果的活动 支持循证做法和政策，以减少VHA的健康差距。这项评估将确定 要解决的高度优先的VHA健康结果和质量差距、关键组织因素和其他背景因素 这可能会影响行动计划，以及减少VHA健康差距的下一步最优先事项。

Background/Rationale: Health disparities are differences in health outcomes and their determinants between segments of the population, as defined by social, demographic, environmental, and geographic attributes. Health disparities have persisted over time in the U.S. for a wide range of conditions affecting vulnerable populations. In the Veterans Health Administration (VHA), where financial barriers to receiving care are minimized, disparities are diminished, but still present for many important health outcomes. Vulnerable populations within VHA include those who are at risk for poor physical, psychological, or social health because of differences in underlying characteristics historically linked to discrimination or exclusion. Though a wide range of studies have examined disparities and gaps in care for selected conditions and vulnerable populations, there has not been a systematic evaluation of diagnosed conditions, mortality, or quality across the entire VHA healthcare user population, and therefore the extent of VHA health and quality gaps for vulnerable Veteran populations is unknown. Objectives: The QUERI-Office of Health Equity Partnered Evaluation Center has four specific aims. It seeks: (1) to assess where disparities currently exist between vulnerable Veteran VHA User groups and reference groups in morbidity and mortality for major conditions that are considered the principal causes of disability and mortality, particularly among vulnerable Veteran populations; (2) to examine gaps and trends in quality of care across treatment settings among vulnerable Veteran populations; (3) to determine the extent to which new models of care alter the association between vulnerable population status and gaps in quality of care; and (4) in partnership with VHA Office of Health Equity, to convene an Advisory Board to examine the context for and identify next steps needed to reduce disparities identified, for the purpose of informing development of action plans to reduce health disparities in VHA. Methods: We are utilizing a population health approach to examine the distribution of diagnosed health conditions, mortality, and healthcare quality across the entire Veteran VHA user population, as defined by their membership or not in vulnerable population groups. These vulnerable groups are defined by: race/ethnicity, sex, socioeconomic status, rurality of residence, service-connected disability status, serious mental illness, and age group. We will use secondary data analysis of VHA administrative data sources that builds on an existing database containing a complete multi-year cohort of VHA patients. Anticipated Impact: In recognition of the potential for policies and interventions to improve health outcomes for vulnerable populations, this Partnered Evaluation Center incorporates activities designed to use findings to support evidence-based practice and policy to reduce health disparities in VHA. This evaluation will identify high priority VHA health outcome and quality gaps to address, key organizational and other contextual factors that may impact action plans, and the highest priority next steps to reduce health disparities in VHA.