Health disparities persist despite VA quality improvements

A review finds gaps between blacks and whites in controlling cardiovascular disease, diabetes and hypertension.

By Carolyne Krupa — Posted May 3, 2011

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Significant quality improvement initiatives in the Veterans Affairs health care system have failed to eliminate health disparities between white and black patients, says a study in the April issue of Health Affairs.

The VA underwent major organizational changes between 1995 and 1999 that led to quality improvements, such as higher cholesterol-screening rates for all patients, said Amal Trivedi, MD, MPH, lead study author and research investigator at the Providence VA Medical Center in Rhode Island.

But racial disparities persist in health outcomes with cardiovascular disease, diabetes and hypertension, he said.

"Quality improvement is not synonymous with disparity reduction," said Dr. Trivedi, assistant professor at the Warren Alpert Medical School of Brown University in Providence, R.I. "It is possible to still be left with lingering disparities in care."

For example, although 96% of whites and 94% of blacks received low-density lipoprotein cholesterol tests in 2009, there was a nine-percentage point gap in LDL control at 68% for whites and 59% for blacks, the study found (link).

Researchers analyzed data on more than 1.1 million patients, including 955,047 whites and 171,207 blacks who received care at VA facilities between 2000 and 2009. They also examined if disparities could be attributed to high numbers of blacks seeking care at low-performing facilities, but found that outcome gaps existed even between blacks and whites seen at the same higher-performing facilities.

Better measures are needed to assess care more thoroughly, Dr. Trivedi said. For example, in addition to measuring blood glucose for diabetes patients, data should be collected on the care physicians provide in response to high glucose levels.

The study comes as the Dept. of Health and Human Services announced April 8 an effort to reduce health disparities (link). The initiative outlines goals for the department and groups that aid underserved communities. They include expanding access to care, training more minorities to work in health care and helping patients navigate the health care system.

"We all need to work together to combat this persistent problem so that we can build healthier communities and a stronger nation," said HHS Secretary Kathleen Sebelius.

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