Despite Improved Quality of Care in the Veterans Affairs Health System, Racial Disparity Persists for Important Clinical Outcomes

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 this study researchers 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.

They also observed a gap in clinical outcomes of as much as 9 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.

April Issue of Health Affairs Focuses on Patient Safety and Health Care Quality

  1. 1. The Ongoing Quality Improvement Journey
  2. 2. A Road Map for Improving the Performance of Performance Measures
  3. 3. Global Trigger Tool' Shows that Adverse Events in Hospitals May be Ten Times Greater Than Previously Measured
  4. 4. Preventing Bloodstream Infections
  5. 5. Measuring the Performance of Individual Physicians by Collecting Data from Multiple Health Plans
  6. 6. Measuring Health Care Performance Now, Not Tomorrow
  7. 7. Despite Improved Quality of Care in the Veterans Affairs Health System, Racial Disparity Persists for Important Clinical Outcomes
  8. 8. The Importance of Transitional Care in Achieving Health Reform
  9. 9. An Early Status Report on the Beacon Communities' Plans for Transformation Via Health Information Technology
  10. 10. A Comparative Study of 11 Local Health Department Organizational Networks
  11. 11. Public Health Performance
  12. 12. A Self-Assessment Process for Accreditation Preparedness
  13. 13. Public Health Delivery Systems
  14. 14. Regionalization in Local Public Health Systems
  15. 15. Public Health Services and Systems Research
  16. 16. A Shot in the Rear, Not a Shot in the Dark
  17. 17. What Predicts Local Public Health Agency Performance Improvement?
  18. 18. Growth of a Scientific Community of Practice
  19. 19. Evolution of Coauthorship in Public Health Services and Systems Research
  20. 20. Resources that May Matter
  21. 21. Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths
  22. 22. Public Health Financial Management Competencies
  23. 23. Decision Science
  24. 24. Public Health Financial Management Needs
  25. 25. Data-Driven Management Strategies in Public Health Collaboratives
  26. 26. Using Geographic Information Systems to Match Local Health Needs with Public Health Services and Programs
  27. 27. Public Health Systems and Services Research
  28. 28. Mapping the Multidisciplinary Field of Public Health Services and Systems Research