America Becoming Racial Trends and Their Consequences: Volume II (2001) / Chapter Skim
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15. Health-Care use in the Veterans Health Administration: Racial Trends and the Spirit of Inquiry
15. Health-Care use in the Veterans Health Administration: Racial Trends and the Spirit of Inquiry
Pages 411-430
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From page 411... ...
RESEARCH ON RACIAL VARIATIONS IN THE PROVISION OF CARE IN THE VETERANS HEALTH ADMINISTRATION To understand VHA research to date regarding racial variations in health care, two issues must be emphasized. First, because virtually all studies have been limited to veterans who receive care in VHA, findings are not immediately generalizable.
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From page 412... ...
On the other hand, primary data are needed for prospective studies designed to better understand whether observed racial variations can be accounted for by factors such as patients' clinical characteristics, health/functional status, preferences for treatment options, or racism. Given the above limitations, why should we nevertheless pursue studies examining the relationship between race and health among veterans receiving care within VHA?
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From page 413... ...
First, observed racial variation may result from underlying differences in clinical factors related to the disease e.g., etiology or severity which would affect appropriateness of procedures taken. If there are racial variations in clinical factors, observed differences may be appropriate for those cases, if all patients receive the tests and procedures needed (Chassin et al., 1987~.
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In addition, coronary artery disease is the leading cause of death for Blacks in the United States (Gillum and Liu, 1984~. Thus, many of the studies of racial variation in health-care use have focused on cardiovascular diagnoses.
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From page 415... ...
This implies that disease biology is not the underlying factor explaining differences in procedure rates, at least as it relates to cardiovascular disease. Racial Differences in the Use of Cerebrovascular Procedures Stroke is the third leading cause of death and a leading cause of disability among adults in the United States (American Heart Association, 1997~.
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From page 416... ...
In a large sample of veterans deemed eligible for CE, we found no difference in clinical appropriateness between a racially stratified sample of Whites and Blacks (Oddone et al., 1997~. However, this analysis fails to account for any differences in the diagnostic evaluation process prior to receipt of carotid angiography.
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From page 417... ...
(1993) found Black patients presenting with chest pain had worse health-related quality of life; but when results were adjusted for sociodemographic factors, comorbid illness, and functional status, no differences remained.
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From page 418... ...
Patient Preferences Although racial variation in the delivery of cardiac procedures was first documented more than a decade ago, the etiology of this disparity remains unclear. As summarized above, data from some studies suggest that neither disease severity nor access to health care completely explains observed differences (Whittle et al., 1993; Ford and Cooper, 1995~.
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From page 419... ...
Studies have documented that Black patients in general are less satisfied with their health care (Blendon et al., 1989~. It is surprising then, that little attention has been paid to racial differences in many patient satisfaction studies.
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From page 420... ...
Other research into the processes of health care has shown that ethnic minority patients receive less empathy, attention, and information from their doctors (Kaplan et al., 1995~. A separate study found racial differences in the use of pain medication for patients treated in an emergency room, with Hispanic patients receiving less analgesia than Whites (Todd et al., 1993~.
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From page 421... ...
Evidence from intensive courses in the patient-physician relationship given as part of residency training programs has shown that residents' knowledge and skills in interviewing can be improved, though the effect sizes between patient groups were too small to assess patient satisfaction and well-being. THE VETERANS HEALTH ADMINISTRATION'S COMMITMENT TO UNDERSTANDING THE REASONS FOR RACIAL DIFFERENCES IN HEALTH CARE VHA research has engaged in a focused program to determine the reasons for ethnic and cultural variations in the delivery of VA health services.
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VHA research adopted an aggressive tactic by soliciting research proposals designed to understand the underpinnings of the observed racial differences. In 1996 VHA research developed an independent committee of experts to oversee racial variation research.
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The advantages of a merged data base for Medicare and Veterans Affairs hospitals. Medical Care 30~5~:377-391.
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1996 Reform of the Veterans Affairs health care system. The New England Journal of Medicine 335~18~:1407-1411.
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From page 427... ...
Monger, and D Matchar 1993 Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack.
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From page 428... ...
Daley, and G.E. Thibault 1994 Racial variations in cardiac procedures use and survival following acute myocardial infarction in the Department of Veteran Affairs.
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From page 429... ...
Good, and R Lofgren 1993 Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system.
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