Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review

Saha, Somnath; Freeman, Michele; Toure, Joahd; Tippens, Kimberly M; Weeks, Christine; Ibrahim, Said A.

doi:10.1007/s11606-008-0521-4

Cited by 259 publications

(199 citation statements)

References 65 publications

(33 reference statements)

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“…Previous studies have systematically reviewed aspects of care at the VA. [5][6][7] Two peer-reviewed articles based on one of these 7 summarized the available evidence on medical 8 and surgical 9 care quality through 2009. This review indicated that in most studies, the care provided in the VA compares favorably to non-VA systems.…”

Section: Introductionmentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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Section: Introductionmentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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“…26 Because quality improvement has been associated with reductions in disparities, 27,28 it is plausible that racial disparities in adherence to CRCS could be nonexistent in the VHA. On the other hand, racial disparities in CRCS adherence could exist within the VHA, because racial disparities in care continue to exist in this setting across a broad range of clinical areas and types of services 29 and because Black patients may have fewer cognitive and environmental resources that contribute to adherence. Existing VA studies provide conflicting evidence about the presence of racial disparities in CRCS, and have significant limitations.…”

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confidence: 99%

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men. These disparities are partially attributable to lower rates of CRC screening (CRCS) by Blacks, 3-5 which has been shown to significantly reduce CRC mortality. [6][7][8][9] To understand what factors contribute to CRCS adherence, researchers have drawn on health behavior theories and have examined such factors as cognitions about screening, social and medical environmental factors, and demographic and health-related factors. [10][11][12] Few studies, however, have explored the extent to which racial disparities in adherence to CRCS are a function of these underlying factors, leaving unanswered questions about the best approaches to promote screening among populations with greater disease burden. [13][14][15][16][17][18][19][20] This study contributes to the broader literature on race differences in CRCS by examining the relative contribution of demographic and health factors, cognitive factors, and environmental factors to racial disparities in CRCS in a nationally representative survey of Veterans Health Affairs (VHA) patients aged 50-75.The VHA is a particularly interesting system within which to examine racial disparities in CRCS because it provides equal access to care to all qualifying veterans, and mandates that all patients be assigned to a primary care provider, both of which diminish barriers to screening that might disproportionally affect r...

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“…[2][3][4][5] In this editorial, we will attempt to synthesize the results of these studies and make recommendations on how to shape future research to reduce, but preferably to completely eliminate, healthcare disparities. These recommendations should be useful to clinicians, researchers, administrations, and policy makers.…”

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confidence: 99%

“…The manuscript by Saha et al 2 reviews the disparity literature in the VA-the largest healthcare provider in the USA. The VA in many ways is an ideal 'laboratory' for exploring disparities because access to health care, which is an important cause of health care disparities, is not an issue, and access to affordable medications, a huge barrier in other settings, is of minimal concern.…”

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confidence: 99%

“…The VA in many ways is an ideal 'laboratory' for exploring disparities because access to health care, which is an important cause of health care disparities, is not an issue, and access to affordable medications, a huge barrier in other settings, is of minimal concern. Saha et al 2 also provide a nice way of framing the current status of the field of disparities. They summarize the state of health disparities research according to three generations of research focusing on racial/ ethnic disparities.…”

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confidence: 99%

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