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其健康和福祉有着深远的影响 作为退伍军人事务部（VA）部长设定的4个总体关键目标之一， 对于VA。我们之前的研究发现，黑人之间的信任程度较低，歧视程度较高 和拉丁裔退伍军人获得退伍军人管理局的医疗保健相比，白色退伍军人。考虑到 考虑到这一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的负面医疗保健经验， 在COVID-19之后。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COVID-19对少数族裔退伍军人的不成比例的影响， 从根本上改变的医疗保健环境的潜在差异影响，以及实施 广泛的疫苗接种和助推器计划，我们的建议集中在一个重要的VA优先事项。我们提出的 研究对确保退伍军人事务部实现其激励退伍军人信任的战略目标的呼吁做出了高度回应 卫生保健系统，以及HSR&D的优先事项，可操作的健康公平研究。此外， 认识到了解种族/民族差异的来源对VA医疗保健的重要性 为了制定有针对性的建议，以提高少数民族的信任与VA医疗保健。 创新性：拟议的护理经验差异（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收集的精确性相结合的设计。 数据分析DICE将能够从检测，到理解，再到形成基础， 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VA的信任之间的关联： 对1,050名黑人、拉丁裔和白色男性和女性进行DICE定量电话调查 来自25个VA医疗中心的退伍军人，他们使用VA门诊或远程医疗服务，或者推迟了护理。 具体目标2。探索退伍军人的经验，通过增加开放式 定性问题的DICE定量电话调查的一个子集的150名男性和女性退伍军人 从我们的目标1样本，并引出可操作的建议，以提高黑人和拉丁裔的信任在弗吉尼亚州。 具体目标3。根据目标1的调查结果和目标2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VA能力 利益相关者改善医疗保健系统，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，我们将在25个VA医疗中心调查1,050名退伍军人， 他们对VA的信任。150名退伍军人还将被问到以下开放式问题： 12个医疗保健领域的信任/不信任来源。我们将使用调查和定性方法， 分别分析目标1和目标2的数据。一个工具包开发小组将研究退伍军人 建议和使用修改后的德尔菲方法将创建一个工具包，旨在改善黑色和 拉丁裔退伍军人在弗吉尼亚州的信任。 实施/下一步：我们将与健康公平办公室，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 退伍军人事务部经过全面培训，并对这项工作提出的建议作出反应。

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.