Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Health Aff (Millwood). 2011 Apr;30(4):707-15. doi: 10.1377/hlthaff.2011.0074.
Both government and private health care systems have engaged in efforts to improve quality, but the effect of these initiatives on racial and ethnic disparities has not been well studied. In the decade following an organizational transformation, the Veterans Affairs (VA) health care system achieved substantial improvements in quality of care with minimal racial disparities for most process-of-care measures, such as rates of cholesterol screenings. However, in our study we observed a striking disconnect between high levels of performance on widely used process measures and modest levels of improvement in clinical outcomes, such as control of blood pressure, blood glucose, and cholesterol levels. We also observed a gap in clinical outcomes of as much as nine percentage points between African American veterans and white veterans. Almost all of the disparity in outcomes in the VA was explained by within-facility disparity, which suggests that VA medical centers need to measure and address racial gaps in care for their patient populations. Moreover, because cardiovascular disease and diabetes are major contributors to racial disparities in life expectancy, the findings of this study and others underscore the urgency of focused efforts to improve intermediate outcomes among African Americans in the VA and other settings.
政府和私人医疗保健系统都在努力提高医疗质量，但这些举措对种族和族裔差异的影响尚未得到充分研究。在组织转型后的十年中，退伍军人事务部（VA）的医疗保健系统在大多数护理过程措施（如胆固醇筛查率）方面取得了实质性的质量改进，同时最小化了种族差异。然而，在我们的研究中，我们观察到一个显著的脱节现象，即在广泛使用的过程措施上表现出色与临床结果（如血压、血糖和胆固醇水平的控制）的适度改善之间存在差距。我们还观察到非裔美国退伍军人和白人退伍军人之间的临床结果差距高达九个百分点。退伍军人事务部的大部分结果差异都可以用设施内差异来解释，这表明退伍军人事务部医疗中心需要衡量和解决其患者群体的护理中的种族差距。此外，由于心血管疾病和糖尿病是导致预期寿命种族差异的主要因素，这项研究和其他研究的结果强调了在退伍军人事务部和其他环境中集中精力改善非裔美国人的中期结果的紧迫性。
