Racial and Ethnic Disparities in Satisfaction with VA Care

描述(由申请人提供)： 项目背景：患者满意度是一个被广泛接受的衡量提供者和医疗保健系统有效性的指标。它也是退伍军人管理局(VA)任务关键型绩效衡量标准。患者满意度与改善健康行为和结果有关。不幸的是，退伍军人中少数族裔的患者满意度低于白人。了解少数族裔退伍军人报告护理满意度下降的原因是必要的，以改善这种差异。项目目标：本研究的具体目标是：具体目标1.在定量调查的基础上，检验患者种族/民族与对退伍军人健康护理总体、门诊、住院和12个领域的满意度之间的关系。具体目标2：基于定性访谈，在非洲裔美国人、西班牙裔美国人和白人的不同样本中，确定对退伍军人健康护理的总体、门诊、住院和12个领域的满意和不满意主题。具体目标3：使用混合方法检查非洲裔美国人、西班牙裔美国人和白人对退伍军人健康护理的总体、门诊、住院和12个领域的满意和不满意主题的差异。项目方法：我们将从25个退伍军人医疗中心随机抽取样本，对750名非洲裔美国人、西班牙裔和白人退伍军人以及一小部分其他少数民族退伍军人(亚裔、太平洋岛民/夏威夷原住民或美国印第安人/阿拉斯加原住民)进行电话采访。这种混合方法设计允许检查种族/民族对满意度结果的直接、中介和/或调节的关联。开放式问题将为对退伍军人医疗保健满意和不满意的原因以及改善具有文化敏感性的退伍军人保健的方法进行正式定性分析提供数据。最后，将使用编码的定性数据的随机效应建模来正式估计和检验种族/民族差异。由于随机效应模型使用开放式的定性数据，因此统计分析使我们的研究超越了对预先确定的满意度项目的依赖，而是捕获了退伍军人自己所描述的对退伍军人医疗保健满意和不满意的非常具体的原因。

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.