QUERI – Quality Enhancement Research Initiative

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Office of Health Equity-QUERI Partnered Evaluation Initiative

Los Angeles, CA

Overview:

Health disparities have persisted over time in the U.S. for a wide range of conditions affecting vulnerable populations. In the VA healthcare system, where financial barriers to receiving care are minimized, disparities are diminished, but still present for many important health outcomes. The Office of Health Equity-QUERI Partnered Evaluation Initiative will use a population health approach to examine the distribution of diagnosed health conditions, mortality, and healthcare quality across the entire VA healthcare system, as defined by Veterans' membership, or not, in vulnerable population groups. Investigators also will evaluate whether characteristics of the healthcare delivery settings (e.g., geography, treatment setting) and of the types of care that individuals use, including new models of care such as Telehealth, influence the quality of care that Veterans receive.

Objectives:

The Office of Health Equity-QUERI Partnered Evaluation Initiative has four specific aims:

1. Assess where disparities exist between vulnerable Veteran populations and reference groups for diseases and conditions that are considered the principal causes of disability and mortality, particularly among vulnerable Veteran populations

2. Examine gaps and trends in quality of healthcare across treatment settings among vulnerable Veteran populations.

3. Determine the extent to which new models of care alter the association between vulnerable population status and gaps in quality of healthcare.

4. In partnership with VA's Office of Health Equity, convene an Advisory Board to examine the context for and identify next steps needed to reduce identified disparities for the purpose of informing development of action plans to reduce disparities in VA healthcare.

This evaluation will identify high-priority VA health outcome and quality gaps to address, key organizational and other contextual factors that may impact action plans, and the highest priority next steps to reduce health disparities in VHA.

Methodology:

Investigators will use a population health approach to examine the distribution of diagnosed health conditions, mortality, and healthcare quality across the entire VA healthcare user population, as defined by their membership or not in vulnerable population groups. These vulnerable groups are defined by: race/ethnicity, sex, socioeconomic status, rurality of residence, service-connected disability status, serious mental illness, and age group. Secondary VA administrative data sources will be used to build on an existing database containing a complete multi-year cohort of VA patients.

Operations Partner:

The key partner is VA's Office of Health Equity, which "strives to advance health equity and reduce health disparities for all, especially vulnerable populations based on racial or ethnic group, religion, socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation, geographic location, or other characteristics historically linked to discrimination or exclusion."

Principal Investigator: Donna L. Washington, MD, MPH; contact at Donna.Washington@va.gov .