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Patient Experience Ratings among Veterans Using the Veterans Health Administration: An Analysis by Race-Ethnicity and
Jessica Y Breland1, W Neil Steers2, Joy Toyama2
1VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA. jessica.breland@va.gov.
Background:
Associations of race-ethnicity and sex with health care experiences are mostly untested. Centering analyses on experiences of racial-ethnic minoritized women could identify areas of improvement to ensure patients have positive experiences, which are associated with positive health outcomes.
Objective:
To identify disparities in health care experiences by concurrently examining race-ethnicity and sex among Veterans Health Administration (VHA) patients.
Design:
Cross-sectional analysis of Survey of Healthcare Experiences of Patients-Patient-Centered Medical Home (SHEP-PCMH) survey data from fiscal years 2020 and 2021.
Participants:
A nationally representative sample of VHA primary care patients. Response rates were 35.5% in 2020 and 33.2% in 2021.
Main Measures:
Weighted linear and logistic regression models assessed differences on nine SHEP-PCMH measures: Access, Timeliness of Urgent Care, Care Coordination, Medication Decision Discussions, Communication, Office Staff Respect, Mental and Emotional Health Assessment, Self-Management Support, and Overall Provider Rating. All models included age and race-ethnicity-by-sex interaction terms. Analyses tested differences in outcomes between racial-ethnic minoritized women and White women, men from the same racial-ethnic minoritized group, and White men, and between White women and White men.
Key Results:
The largest number of disparities were found on the Office Staff Respect measure, with the largest disparity seen for Native Hawaiian or Pacific Islander women who reported less positive experiences (56%) than White women (70%) and White men (74%). Asian, Black, Hispanic, and White women each had Office Staff Respect disparities compared with White men. There were also several disparities across groups of racial-ethnic minoritized women on the Access measure, primarily when compared with White men.
Conclusions:
These analyses provide important information that remains undetected when analyses focus separately on one-dimensional characteristics. VHA should improve training in customer service and ensure timely access to care to improve patient experiences for all veterans using VHA care.
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