Racial and Ethnic Disparities in Satisfaction with VA Care

描述（由申请人提供）： 项目背景：患者满意度是衡量医疗服务提供者和医疗保健系统有效性的一个被广泛接受的指标。它也是退伍军人管理局（VA）的关键任务绩效指标。患者满意度与改善的健康行为和结果有关。不幸的是，少数族裔退伍军人的病人满意度低于白人。了解少数族裔退伍军人报告对护理的满意度下降的原因是必要的，以改善这种差距。项目目标：本研究的具体目标是：具体目标1。基于定量调查，检查患者种族/民族与总体、门诊、住院和12个VA医疗保健领域满意度之间的相关性。具体目标2。确定主题的满意度和不满意的整体，门诊，住院，和12个领域的VA医疗保健在不同的样本的非裔美国人，西班牙裔和白人的基础上进行定性访谈。具体目标3：使用混合的方法来检查满意度和不满意的主题的差异与整体，门诊，住院，和12个领域的VA卫生保健之间的非洲裔美国人，西班牙裔和白人。项目方法：使用从25个VA医疗中心抽取的随机样本，我们将使用封闭式和开放式问题对750名非裔美国人、西班牙裔和白色退伍军人以及其他少数民族退伍军人（亚洲人、太平洋岛民/夏威夷土著人或美洲印第安人/阿拉斯加土著人）进行电话采访。这种混合方法的设计允许检查的直接，介导和/或缓和的种族/民族的满意度结果的关联。开放式问题将提供数据，对退伍军人管理局医疗保健满意和不满意的原因以及改善退伍军人管理局文化敏感的医疗保健的方法进行正式的定性分析。最后，将使用编码定性数据的随机效应建模来正式估计和检验人种/种族差异。由于随机效应建模使用开放式的定性数据，这种统计分析使我们的研究能够超越对预先建立的满意度项目的依赖，而是捕捉退伍军人自己所描述的对VA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.