title: Understanding racial and ethnic differences in patient experiences with outpatient health care in Veterans Affairs Medical Centers.
abstract: BACKGROUND
  Racial and ethnic differences in patient health care experiences have not been well examined in the Veterans Affairs (VA) Healthcare System.
  
  
  OBJECTIVE
  To examine racial/ethnic differences in outpatient health care experiences within and between VA medical facilities.
  
  
  METHODS
  We assessed within-facility and between-facility racial/ethnic differences in responses to the 2010 VA Survey of Healthcare Experiences of Patients using mixed-effects multinomial regression.
  
  
  METHODS
  A total of 211,459 respondents (53.2%) to a random survey of outpatients from 910 VA medical facilities (71.9% non-Hispanic white, 15.1% non-Hispanic black, 6.4% Hispanic, and 6.7% Other race/ethnicity).
  
  
  METHODS
  Negative and positive patient-reported experiences in 8 domains of health care.
  
  
  RESULTS
  Between-facility effects for black race were higher for 7 domains of negative experiences [risk differences (RDs): 0.37% to 1.64%] and lower for 6 domains of positive experiences (RDs: -0.69% to -2.54%). Between-facility effects for Hispanic ethnicity were higher for 5 domains of negative experiences (RDs: 0.60%-1.34%) and lower for 5 domains of positive experiences (RDs: -1.00% to -1.88%). Hispanic ethnicity was also associated with higher within-facility rates of positive experiences for 5 domains of care (RDs: 2.97%-4.08%). Other race/ethnicity was associated with significantly higher within-facility rates of negative experiences (RDs: 2.04%-3.95%) and lower rates of positive experiences for all 8 domains (RDs: -2.05% to -4.70%).
  
  
  CONCLUSIONS
  In a national random sample of Veterans managed in the VA Healthcare System, we demonstrated significant within-facility and between-facility racial and ethnic differences in outpatient health care experiences, with differing patterns for each minority group.
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, VA Center for Health Equity Research and Promotion, 7180 Highland Drive (151C-H), Pittsburgh, PA 15206, USA. leslie.hausmann@gmail.com
authors.forename: Leslie R M
authors.initials: LR
authors.lastname: Hausmann
authors.forename: Shasha
authors.initials: S
authors.lastname: Gao
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.forename: James H
authors.initials: JH
authors.lastname: Schaefer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*