Medical Care Received by Minority Military Veterans Examined in New AHRQ Study

A new AHRQ-funded study suggests that minority military veterans are getting disproportionately less care at Veterans Health Administration (VHA) facilities that have not fully adopted Patient Aligned Care Team (PACT). PACT is based on the patient-centered medical home model of medical teams that provide proactive, personalized patient care geared toward wellness and disease prevention. Because most minority veterans obtain care at VHA facilities that are less likely to have implemented PACT, they may not benefit from likely improvements in care if PACT had been in place, according to the study. However, the authors added that disparities may be due to variations in care across different VHA facilities, rather than minorities being treated differently than whites at the same facilities. The analysis included nearly 830 VHA outpatient primary care facilities serving 6 million veterans during FY 2012. Facilities were categorized as “high,” “medium” and “low” based on the percentage of their minority patients. The study found that facilities with higher percentages of minority patients were associated with lower levels of PACT implementation. The study, “A First Look at PCMH Implementation for Minority Veterans: Room for Improvement,” and abstract were published in the March issue ofMedical Care.

2016 Mar;54(3):253-61. doi: 10.1097/MLR.0000000000000512.

A First Look at PCMH Implementation for Minority Veterans: Room for Improvement.

Hernandez SE1, Taylor L, Grembowski D, Reid RJ, Wong E, Nelson KM, Liu CF, Fihn SD, Hebert PL.

Author information

Abstract

BACKGROUND:

Implementation of Patient Aligned Care Teams (PACT), a patient-centered medical home model, has been inconsistent among the >900 primary care facilities in the Veterans Health Administration.

OBJECTIVE:

Estimate if the degree of PACT implementation at a facility varied with the percentage of minority veteran patients at the facility.

RESEARCH DESIGN:

Cross-sectional, facility-level analysis of PACT implementation measures in 2012.

SUBJECTS:

Veterans Health Administration hospital-based and community-based primary care facilities.

MEASURES:

We used a previously validated PACT Implementation Progress Index (Pi) and its 8 domains: access, continuity of care, care coordination, comprehensiveness, self-management support, and patient-centered care and communication, shared decision-making domains, and team functioning. Facilities were categorized as low (<5.2%, n=208), medium (5.2%-25.8%, n=413), and high (>25.8%, n=206) percent minoritybased on the percent of their own veteran population.

RESULTS:

Most minority veterans received care in high minority (69%) and medium minority facilities (29%). In adjusted analyses, medium and highminority facilities scored 0.773 (P=0.009) and 0.930 (P=0.008) points lower on the Pi score relative to low minority facilities. Relative to low minorityfacilities, both medium and high minority facilities were less likely of having high Pi scores (≥2) and more likely of having low Pi scores (≤-2). Both medium and high minority facilities had the same 3 domain scores lower than low minority facilities (care coordination, comprehensiveness, and self-management).

CONCLUSION:

Overall PACT implementation varied with respect to the racial/ethnic composition of a facility, with medium and high minorityfacilities having a lower implementation scores.