Boden Matt, Katz Ira, Harris A H S, Hoff Rani, Trafton Jodie A
Program Evaluation and Resource Center, Office of Mental Health, Veterans Health Administration.
Office of Mental Health, Veterans Health Administration.
Psychol Serv. 2025 Aug;22(3):584-595. doi: 10.1037/ser0000936. Epub 2025 Apr 17.
The Veterans Health Administration (VHA) has committed to increasing health equity for all veterans, which is needed to address disparities in health care and outcomes experienced by Black VHA patients. In this cross-sectional retrospective observational study, we analyzed VHA operations data on all patients receiving mental health treatment at VHA in fiscal year 2021 ( = 1,602,865). Facility-level negative binomial regressions demonstrated that Black patients were disproportionately treated at large, complex, urban facilities in the Southern United States that had higher overall volumes of mental health care and staff but lower mental health staffing ratios and less care for each patient. Though they utilized facilities with lower visits and hours per patient, Black versus non-Black patients had on average more visits and hours per patient. Accounting for these gaps using patient-level Kitagawa-Oaxaca-Blinder (KOB) decomposition analyses, we found (a) negligible and small within-facility effects, (b) between-facility effects that demonstrated that Black patients would have received more treatment than non-Black patients had they utilized facilities in the same proportions as non-Black patients, and (c) excluded variables in unadjusted KOB and excluded variables and covariates (e.g., age, homeless treatment receipt) in adjusted KOB most strongly accounted for gaps. Combining facility-level analyses with novel use of patient-level KOB revealed nuance in the potential inequities experienced by Black VHA mental health patients while demonstrating the need for additional research to examine whether Black patients receive the proper treatments for their mental health conditions and at the optimum dose. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
退伍军人健康管理局（VHA）致力于提高所有退伍军人的健康公平性，这对于解决黑人VHA患者在医疗保健和治疗结果方面的差异是必要的。在这项横断面回顾性观察研究中，我们分析了2021财年在VHA接受心理健康治疗的所有患者的VHA运营数据（n = 1,602,865）。机构层面的负二项回归表明，黑人患者在美国南部大型、复杂的城市机构接受治疗的比例过高，这些机构心理健康护理和工作人员的总体数量较多，但心理健康人员配备比例较低，且每位患者得到的护理较少。尽管黑人患者使用的机构每位患者的就诊次数和时长较少，但与非黑人患者相比，他们平均每位患者的就诊次数和时长更多。通过患者层面的北川 - 瓦哈卡 - 布林德（KOB）分解分析来考虑这些差距，我们发现：（a）机构内部的影响微不足道且较小；（b）机构间的影响表明，如果黑人患者与非黑人患者以相同比例使用机构，他们会比非黑人患者接受更多治疗；（c）未调整的KOB中的排除变量以及调整后的KOB中的排除变量和协变量（如年龄、接受无家可归者治疗情况）最能解释差距。将机构层面的分析与患者层面KOB的新应用相结合，揭示了黑人VHA心理健康患者所经历的潜在不公平现象的细微差别，同时表明需要进行更多研究，以检查黑人患者是否针对其心理健康状况接受了适当的治疗以及是否以最佳剂量接受治疗。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
