Project Background: Patient satisfaction is a widely accepted measure of the effectiveness of providers and healthcare systems. It is also a Veterans Administration (VA) mission-critical performance measure. Patient satisfaction is linked to improved health behaviors and outcomes. Unfortunately, patient satisfaction for minority Veterans is lower in the VA than it is for whites. Understanding reasons why minority Veterans report decreased satisfaction with care is necessary in order to ameliorate this disparity. Project Objectives:
The Specific Aims of this study are:
Specific Aim 1. To examine the associations between patient race/ethnicity and satisfaction with overall, outpatient, inpatient, and 12 domains of VA health care based on a quantitative survey.
Specific Aim 2. To identify themes of satisfaction and dissatisfaction with overall, outpatient, inpatient, and 12 domains of VA health care in a diverse sample of African Americans, Hispanics, and whites based on a qualitative interview.
Specific Aim 3 : To use mixed methods to examine differences in themes of satisfaction and dissatisfaction with overall, outpatient, inpatient, and 12 domains of VA health care among African Americans, Hispanics, and whites. Project Methods: Using a random sample drawn from 25 VA Medical Centers, we will conduct telephone interviews from the VA Pittsburgh Healthcare System using both closed and open- ended questions with 750 African American, Hispanic, and white Veterans as well as a small sample of other minority Veterans (Asian, Pacific Islander/Native Hawaiian, or American Indian/Native Alaskan). This mixed-methods design allows for the examination of the direct, mediated and/or moderated associations of race/ethnicity on satisfaction outcomes. The open- ended questions will provide data for a formal qualitative analysis of both reasons for satisfaction and dissatisfaction with VA health care and ways to improve VA care that are culturally sensitive. Finally, random effects modeling of coded qualitative data will be used to formally estimate and test racial/ethnic differences. Because the random effects modeling uses open-ended, qualitative data this statistical analysis allows our study to go beyond reliance on pre-established satisfaction items, and instead capture very specific reasons for satisfaction and dissatisfaction with VA health care as described by the Veterans themselves.

Public Health Relevance

African Americans and Hispanics report lower levels of satisfaction with VA health care than whites. Given the VA's commitment to providing high quality care to all patients, it is critical to understand the reasons underlying this disparity so that effective and appropriate interventions can be developed to reduce them. Our study will use an innovative approach to pinpoint key modifiable areas of dissatisfaction for African American and Hispanic Veterans, as well as Veteran-identified potential solutions to improve care. This will be the first step toward the development of targeted interventions designed to improve satisfaction with VA health care among the growing proportion of Veterans who are racial or ethnic minorities.

Agency
National Institute of Health (NIH)
Institute
Veterans Affairs (VA)
Type
Non-HHS Research Projects (I01)
Project #
5I01HX000501-02
Application #
8597285
Study Section
HSR-2 Determinants of Patient Response to Care (HSR2)
Project Start
2011-11-01
Project End
2014-10-31
Budget Start
2012-11-01
Budget End
2013-10-31
Support Year
2
Fiscal Year
2013
Total Cost
Indirect Cost
Name
Veterans Health Administration
Department
Type
DUNS #
033127569
City
Pittsburgh
State
PA
Country
United States
Zip Code
15206