title: A national study of racial differences in pain screening rates in the VA health care system.
abstract: OBJECTIVE
  To determine whether black patients are less likely to be screened for pain than white patients.
  
  
  METHODS
  A sample of 25,382 black and 220,122 non-Hispanic white Veterans Affairs (VA) patients was identified among the panel surveyed in the ambulatory care module of the 2007 Survey of Health Care Experiences of Patients.
  
  
  METHODS
  This was a cross-sectional analysis of documentation of a pain score in the electronic medical record at the patient's Survey of Health Care Experiences of Patients index visit. Hierarchical logistic regression analyses were used to examine the association between race and documentation of pain screening.
  
  
  RESULTS
  After accounting for site and whether the patient was a new or established primary care patient, black VA patients were significantly less likely than their white counterparts to be screened for pain, odds ratio: 0.79, P<0.0001, with estimated screening rates of 78% and 82% for black and white established primary care patients at a typical VA site, respectively. Further adjusting for demographics, medical and psychological comorbidity, prescription of pain medication, and health care utilization reduced the odds ratio to 0.86, P<0.0001). Additional analyses revealed that this reduction in odds ratio was primarily explained by higher rates of outpatient visits to the VA in the previous 2 years among black patients, which was associated with lower rates of screening at the index visit.
  
  
  CONCLUSIONS
  Rates of screening were lower among black patients. The magnitude of this disparity was small and was explained, in part, by racial variation in prior health care utilization.
authors.affiliation: Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), VA Minneapolis Healthcare System 55417, USA. diana.burgess@va.gov
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Burgess
authors.forename: Amy A
authors.initials: AA
authors.lastname: Gravely
authors.forename: David B
authors.initials: DB
authors.lastname: Nelson
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.forename: Robert D
authors.initials: RD
authors.lastname: Kerns
authors.forename: Diana M
authors.initials: DM
authors.lastname: Higgins
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Partin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D044469:Racial Groups; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data