title: Racial Differences in Satisfaction with VA Health Care: A Mixed Methods Pilot Study.
abstract: BACKGROUND
  As satisfied patients are more adherent and play a more active role in their own care, a better understanding of factors associated with patient satisfaction is important.
  
  
  OBJECTIVE
  In response to a United States Veterans Administration (VA) Hospital Report Card that revealed lower levels of satisfaction with health care for African Americans compared to Whites, we conducted a mixed methods pilot study to obtain preliminary qualitative and quantitative information about possible underlying reasons for these racial differences.
  
  
  METHODS
  We conducted telephone interviews with 30 African American and 31 White veterans with recent inpatient and/or outpatient health care visits at three urban VA Medical Centers. We coded the qualitative interviews in terms of identified themes within defined domains. We summarized racial differences using ordinal logistic regression for Likert scale outcomes and used random effects logistic regression to assess racial differences at the domain level.
  
  
  RESULTS
  Compared to Whites, African Americans were younger (p < 0.001) and better educated (p = 0.04). Qualitatively, African Americans reported less satisfaction with trust/confidence in their VA providers and healthcare system and less satisfaction with patient-provider communication. Quantitatively, African Americans reported less satisfaction with outpatient care (odds ratio = 0.28; 95 % confidence interval (CI) 0.10-0.82), but not inpatient care. At the domain level, African Americans were significantly less likely than Whites to express satisfaction themes in the domain of trust/confidence (odds ratio = 0.36; 95 % CI 0.18-0.73).
  
  
  CONCLUSIONS
  The current pilot study demonstrates racial differences in satisfaction with outpatient care and identifies some specific sources of dissatisfaction. Future research will include a large national cohort, including Hispanic veterans, in order to gain further insight into the sources of racial and ethnic differences in satisfaction with VA care and inform future interventions.
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA. Susan.Zickmund@va.gov.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA. Susan.Zickmund@va.gov.
authors: Susan L
authors: SL
authors: Zickmund
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.
authors: Kelly H
authors: KH
authors: Burkitt
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.
authors: Shasha
authors: S
authors: Gao
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, 15261, USA.
authors: Roslyn A
authors: RA
authors: Stone
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
authors: Keri L
authors: KL
authors: Rodriguez
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.|Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA.
authors: Galen E
authors: GE
authors: Switzer
authors: Philadelphia VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, PA, 19104, USA.
authors: Judy A
authors: JA
authors: Shea
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Psychology, Chatham University, Pittsburgh, PA, 15232, USA.
authors: Nichole K
authors: NK
authors: Bayliss
authors: Gender Violence and Health Centre, London School of Hygiene and Tropical Medicine, London, England.
authors: Rebecca
authors: R
authors: Meiksin
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
authors: Mary B
authors: MB
authors: Walsh
authors: VA Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
authors: Michael J
authors: MJ
authors: Fine
mesh_terms: D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D000553:Ambulatory Care; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000208:ethnology*; D010865:Pilot Projects; D036301:Qualitative Research; D035502:Trust; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Access; Health equity; Patient satisfaction; Provider-patient communication; Racial disparities; Trust