Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus.
Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus.
JAMA Netw Open. 2024 Feb 5;7(2):e2356600. doi: 10.1001/jamanetworkopen.2023.56600.
Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups.
To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022.
The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group.
Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including "good medical care" and telehealth as a "comfortable/great option," as were some negative items, including "long waits/delays in getting care," "transportation/traffic challenges," and "anxiety/stress/fear." Reporting "no impact" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. "Impersonal/cursory" telehealth experiences and the need for "more personal/attentive" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect.
In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
在退伍军人健康管理局（VHA）推进公平以患者为中心的护理，需要了解独特患者群体的不同体验。
通过对黑人和白人种族以及男性和女性退伍军人在 VHA 中的护理体验进行比较定性分析，为改善 VHA 公平性制定全面策略。
设计、地点和参与者：这项定性研究使用了一种称为自由列表的技术，这是一种在城市学术 VHA 医疗中心进行的、通过列表形式引出反应的人类学技术，研究时间为 2021 年 8 月 2 日至 2022 年 2 月 9 日。参与者包括患有慢性高血压的退伍军人。每个项目的个人列表长度、列表中的项目顺序以及列表之间的项目频率，都用于计算每个项目的显着性得分，从而可以比较不同群体内部和之间的显着词语和主题。参与者被要求回答当前对 VHA 护理的看法、过去一年的挑战、虚拟护理、变革建议以及种族主义经历。数据分析于 2022 年 2 月 10 日至 9 月 30 日进行。
为每个群体计算了史密斯显着性指数，该指数衡量每个单词或短语的频率和排名。
通过种族（24 名黑人和 25 名白人）和性别（24 名男性和 25 名女性）比较了来自 49 名退伍军人（12 名黑人男性、12 名黑人女性、12 名白人男性和 13 名白人女性）的回复。平均（SD）年龄为 64.5（9.2）岁。一些积极的项目在种族和性别之间都很突出，包括“良好的医疗护理”和远程医疗作为“舒适/绝佳选择”，一些负面项目也很突出，包括“长时间等待/延迟接受护理”、“交通/交通挑战”和“焦虑/压力/恐惧”。报告称种族主义对 VHA 医疗保健体验“无影响”在种族和性别之间都很突出；然而，与不涉及白人参与者的种族相关的不专业治疗和主动避免种族相关冲突的报告则因种族而异。人际互动的体验也存在差异。“冷漠/草率”的远程医疗体验和对“更个人化/更专注”护理的需求在女性和黑人参与者中很突出，但在男性或白人参与者中并不突出，他们将 VHA 护理与礼貌和尊重联系在一起。
在这项关于退伍军人体验的定性自由列表研究中，基于种族和性别的人际护理体验的差异为改善公平、以患者为中心的 VHA 护理提供了见解。未来的研究和干预措施可以集中在确定种族和性别内外更广泛类别的差异，并加强改善对不同退伍军人群体的尊重和个性化护理的努力。
