Disparities in Trust: COVID-19's Impact on Minority Veterans' Healthcare Experiences

背景：患者对医疗系统的信任对他们的健康和福祉有深远的影响 而且，作为退伍军人事务部(退伍军人事务部)秘书设定的4个总体关键目标之一，是高度优先的 退伍军人事务部。我们之前的研究发现，黑人的信任度较低，受歧视程度较高 与白人退伍军人相比，拉丁裔退伍军人获得退伍军人医疗服务。考虑到不成比例的 该流行病对少数群体社区的影响以及种族和数字鸿沟之间的重叠， 重要的是要更好地了解黑人和拉丁裔退伍军人在 新冠肺炎的余波。这些信息对于通过有针对性的建议改善护理至关重要。 意义/影响：考虑到新冠肺炎对少数族裔退伍军人的不成比例影响， 从根本上改变医疗保健环境的潜在差异影响，以及实施 在广泛的疫苗接种和强化计划中，我们的建议重点放在退伍军人管理局的一个重要优先事项上。我们的建议 研究高度响应号召，以确保退伍军人管理局实现其激励退伍军人信任的战略目标 医疗保健系统，以及HSR&D对可采取行动的健康公平研究的优先事项。Va也 认识到了解种族/民族差异的根源的重要性，并信任退伍军人管理局的医疗保健 以便制定有针对性的建议，以改善少数人对退伍军人管理局医疗保健的信任。 创新性：建议的护理体验差异(DICE)研究使用了一种新的混合方法 将定性数据收集的洞察力和丰富性与定量数据的精确度相结合的设计 数据分析。骰子将能够从检测到理解，再到形成 使用退伍军人自己的建议进行干预。 具体目标1.通过以下方式检查退伍军人的种族/民族与他们对退伍军人的信任之间的联系 对1050名黑人、拉丁裔和白人男女进行骰子定量电话调查 来自25个退伍军人医疗中心的退伍军人，他们使用退伍军人管理局的门诊或远程医疗服务，或被推迟护理。 具体目标2.探索退伍军人的经验，通过增加开放式的 关于骰子的定性问题对150名男女退伍军人进行定量电话调查 从我们的目标1个样本，并引出可行的建议，以改善黑人和拉丁裔在退伍军人管理局的信任。 具体目标3。使用目标1的调查结果和目标2的经验丰富的建议，我们将与我们的 运营合作伙伴和主要供应商开发和传播工具包和培训，以增强退伍军人管理局的能力 利益攸关方改善医疗保健系统，以在黑人和拉丁裔退伍军人中建立信任。 方法：使用种族/民族分层，我们将调查25个退伍军人医疗中心的1050名退伍军人 他们对退伍军人事务部的信任经历。150名退伍军人还将被问到关于以下方面的开放式问题 卫生保健12个领域的信任/不信任来源。我们将采用调查和定性的方法 分析分别来自目标1和目标2的数据。一个工具包开发小组将检查这位老兵 建议和使用修改后的Delphi方法将创建一个工具包，旨在改进Black和 拉丁裔退伍军人对退伍军人事务部的信任。 实施/下一步：我们将与卫生公平办公室、退伍军人体验办公室、 分析和性能集成办公室以及供应商动态集成服务，以确保 退伍军人管理局接受了彻底的培训，并对这项工作提出的建议作出了反应。

Background: Patients’ trust in their healthcare system has a profound impact on their health and well-being and, as 1 of 4 overall key goals set by the Secretary of the Department of Veteran Affairs (VA), is a high priority for VA. Our previous research found lower levels of trust and higher perceived discrimination amongst Black and Latinx Veterans obtaining VA medical care compared to White Veterans. Considering the disproportionate impact of the pandemic on minority communities and the overlap between racial and digital divides, it is important to better understand the negative healthcare experiences of Black and Latinx Veterans in the aftermath of COVID-19. This information will be critical to improve care through targeted recommendations. Significance/Impact: Considering the disproportionate impact of COVID-19 on minority Veterans, the potential differential effects of a radically transformed healthcare environment, and the need to implement widespread vaccination and booster programs, our proposal focuses on an important VA priority. Our proposed research is highly responsive to the call to ensure the VA meets its strategic goal of inspiring Veterans to trust the healthcare system, as well as to HSR&D’s priority for actionable health equity research. VA also recognizes the importance of understanding the source of racial/ethnic disparities in trust with VA medical care in order to develop targeted recommendations to improve minority trust with VA health care. Innovativeness: The proposed Disparities In Care Experiences (DICE) study uses a novel mixed methods design that integrates the insights and richness of qualitative data collection with the precision of quantitative data analysis. DICE will be able to traverse from detection, to understanding, to forming the basis for interventions using Veterans’ own recommendations. Specific Aim 1. To examine the associations between Veterans’ race/ethnicity and their trust in the VA by conducting the DICE quantitative telephone survey with 1,050 Black, Latinx, and White male and female Veterans from 25 VA Medical Centers who used VA outpatient or telehealth services, or had care deferred. Specific Aim 2. To explore Veterans’ experiences contributing to trust in the VA by adding open -ended qualitative questions to the DICE quantitative telephone surveys for a subset of 150 male and female Veterans from our Aim 1 sample and to elicit actionable recommendations for improving Black and Latinx trust in VA. Specific Aim 3. Using the Aim 1 survey results and the Aim 2 Veteran recommendations, we will work with our operational partners and a key vendor to develop and disseminate a toolkit and training to empower VA stakeholders to improve the healthcare system to engender trust amongst Black and Latinx Veterans. Methodology: Using racial/ethnic stratification we will survey 1,050 Veterans at 25 VA medical centers on their experience of trust in VA. One hundred and fifty Veterans will also be asked open-ended questions about sources of trust/distrust across 12 domains of health care. We will use survey and qualitative methods to analyze the data from Aims 1 and 2, respectively. A toolkit development group will examine the Veteran recommendations and using a modified Delphi approach will create a toolkit designed to improve Black and Latinx Veterans’ trust in VA. Implementation/Next steps: We will partner with the Office of Health Equity, the Veteran Experience Office, the office of Analytics and Performance Integration, and vendor Dynamic Integration Services to ensure that the VA is thoroughly trained and responsive to the recommendations resulting from this work.