Assessment of Racial Bias within the Risk Analysis Index of Frailty.

Objective: Our objective was to assess potential racial bias within the Risk Analysis Index (RAI).

Background: Patient risk measures are rarely tested for racial bias. Measures of frailty, like the RAI, need to be evaluated for poor predictive performance among Black patients.

Care Fragmentation, Social Determinants of Health, and Postoperative Mortality in Older Veterans.

Introduction: Veterans Affairs Surgical Quality Improvement Program (VASQIP) benchmarking algorithms helped the Veterans Health Administration (VHA) reduce postoperative mortality. Despite calls to consider social risk factors, these algorithms do not adjust for social determinants of health (SDoH) or account for services fragmented between the VHA and the private sector. This investigation examines how the addition of SDoH change model performance and quantifies associations between SDoH and 30-d postoperative mortality.

Facility-Level Variation in Racial Disparities in Anticoagulation for Atrial Fibrillation: The REACH-AF Study.

Background: Oral anticoagulation reduces stroke risk for patients with atrial fibrillation (AF). Prior research demonstrates lower anticoagulant prescribing in Black than in White individuals but few studies have examined racial differences in facility-level anticoagulant prescribing for AF.

Objective: To assess variation in anticoagulant initiation by race within Veterans Health Administration (VA) facilities.

Participation of Veterans Affairs Medical Centers in veteran-centric community-based service navigation networks: A mixed methods study.

Objective: To understand the determinants and benefits of cross-sector partnerships between Veterans Affairs Medical Centers (VAMCs) and geographically affiliated AmericaServes Network coordination centers that address Veteran health-related social needs.

Data Sources And Setting: Semi-structured interviews were conducted with AmericaServes and VAMC staff across seven regional networks. We matched administrative data to calculate the percentage of AmericaServes referrals that were successfully resolved (i.

Developing a brief assessment of social risks for the Veterans Health Administration Survey of Healthcare Experiences of Patients.

Objective: To determine whether a 6- or 12-month look-back period affected rates of reported social risks in a social risk survey for use in the Veterans Health Administration and to assess associations of social risks with overall health and mental health.

Study Design: Cross-sectional survey of respondents randomized to 6- or 12-month look-back period.

Data Sources And Study Setting: Online survey with a convenience sample of Veterans in June and July 2021.

Increasing consumer engagement: tools to engage service users in quality improvement or implementation efforts.

Introduction: Engaging service users or consumers in quality improvement or implementing a new service is important across settings and may reduce health inequities. Implementation strategies leveraging consumer engagement are neither commonly used nor robustly operationalized in implementation science. Implementers (e.

Disparities in Guideline-Recommended Statin Use for Prevention of Atherosclerotic Cardiovascular Disease by Race, Ethnicity, and Gender : A Nationally Representative Cross-Sectional Analysis of Adults in the United States.

Background: Although statins are a class I recommendation for prevention of atherosclerotic cardiovascular disease and its complications, their use is suboptimal. Differential underuse may mediate disparities in cardiovascular health for systematically marginalized persons.

Objective: To estimate disparities in statin use by race-ethnicity-gender and to determine whether these potential disparities are explained by medical appropriateness of therapy and structural factors.

Understanding the Context for Incorporating Equity into Quality Improvement Throughout a National Health Care System.

Purpose: Although health care systems aspire to deliver equitable care, practical tools that empower the health care workforce to weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews that informed the development of a user-centered tool to support equity-focused QI.

Methods: Semistructured interviews were conducted from February to April of 2019.

Assessing an electronic self-report method for improving quality of ethnicity and race data in the Veterans Health Administration.

Objective: Evaluate self-reported electronic screening () in a VA Transition Care Management Program (TCM) to improve the accuracy and completeness of administrative ethnicity and race data.

Materials And Methods: We compared missing, declined, and complete (neither missing nor declined) rates between (1) (ethnicity and race entered into electronic tablet directly by patient using eScreening), (2) (Veteran-completed paper form plus interview, data entered by staff), and (3) (multiple processes, data entered by staff). The TCM-eScreening ( = 7113) and TCM-EHR groups ( = 7113) included post-9/11 Veterans.

Analysis by Gender and Race and Ethnicity of Reviewers and Awardees for Intramural Research Funding in the Veterans Health Administration.

Importance: Underrepresentation of women and racial and ethnic minority individuals among reviewers and funded investigators in health research has been widely reported. It is unknown whether such underrepresentation exists in the Veterans Health Administration (VHA).

Objective: To describe gender and racial and ethnic makeup of VHA Health Services Research and Development (HSR&D) study sections and funding awardees and to explore the associations between gender and racial and ethnic makeup of study sections and awardees who were women and racial and ethnic minority individuals.

Interaction between Legal and Social Needs in Their Association with Self-rated Health in a National Sample of Veterans.

Many health-related social needs, such as financial insecurity, are interconnected with legal needs. However, little is known about which social needs are more likely to be associated with legal needs, or whether legal and other needs interact to affect health. Using data from a 2020 national mailed survey assessing social needs among Veterans who had or were at risk for cardiovascular disease (N=2,801) and linked administrative data, linear regression models tested interactions between legal and other social needs, and their associations with self-rated health.

Association of Neighborhood Disadvantage and Anticoagulation for Patients with Atrial Fibrillation in the Veterans Health Administration: the REACH-AF Study.

Background: Atrial fibrillation (AF) is a common arrhythmia, the management of which includes anticoagulation for stroke prevention. Although disparities in anticoagulant prescribing have been well documented for individual socioeconomic factors, less is known about the association of neighborhood-level disadvantage and anticoagulation for AF.

Objective: To assess the association between neighborhood disadvantage and anticoagulant initiation for patients with incident AF.

Analysis of Initiating Anticoagulant Therapy for Atrial Fibrillation Among Persons Experiencing Homelessness in the Veterans Affairs Health System.

This cohort study examines the use of anticoagulant therapy among persons who have experienced homelessness treated for atrial fibrillation in the Veterans Affairs Health System.

Temporal variation in individual social risk factors associated with testing positive for SARS-CoV-2 among veterans in the veterans health administration.

Purpose: Marginalized communities have been disproportionally impacted by SARS-CoV-2. How the associations between social determinants of health and the risk of SARS-CoV-2 infection shifted across time is unknown. In this evaluation, we examine individual-level social determinants of health as social risk factors for SARS-CoV-2 infection across the first 12 months of the pandemic among US Veterans.

Determining feasibility of incorporating consumer engagement into implementation activities: study protocol of a hybrid effectiveness-implementation type II pilot.

Introduction: Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement in healthcare implementation, partially because no formal guidance exists. We will create and pilot a toolkit of methods to engage consumers from the US' Veterans Health Administration (VHA) in selecting and tailoring implementation strategies.

Association of Race and Ethnicity and Anticoagulation in Patients With Atrial Fibrillation Dually Enrolled in Veterans Health Administration and Medicare: Effects of Medicare Part D on Prescribing Disparities.

Background: Racial and ethnic disparities in anticoagulation exist in atrial fibrillation management in Medicare and the Veterans Health Administration, but the influence of dual Veterans Health Administration and Medicare enrollment is unclear. We compared anticoagulant initiation by race and ethnicity in dually enrolled patients and assessed the role of Medicare part D enrollment on anticoagulation disparities.

Methods: We identified patients with incident atrial fibrillation (2014-2018) dually enrolled in Veterans Health Administration and Medicare.

Race Differences in Postacute Physical Therapy Utilization and Patient-Reported Function After Total Knee Arthroplasty.

Objective: This observational cohort study included patients of Black and White race and non-Hispanic ethnicity with end-stage knee osteoarthritis who were scheduled to receive total knee arthroplasty (TKA) surgery. Our objective was to examine whether race differences exist in the use of physical therapy (PT) across all postacute settings and to examine patient-reported physical function following TKA.

Methods: We collected pre- and postoperative physical function data and postoperative rehabilitation data on 104 Black and White individuals undergoing TKA.

Sex differences in atrial fibrillation: patient-reported outcomes and the persistent toll on women.

Background: Women have worse patient-reported outcomes in atrial fibrillation (AF) than men, but the reasons remain poorly understood. We investigated how comorbid conditions, treatment, social factors, and their modification by sex would attenuate sex-specific differences in patient-reported outcomes in AF.

Methods: In a cohort with prevalent AF we measured patient-reported outcomes with the Short-Form-12 (SF-12, an 8-domain quality of life measure), and the AF Effect on QualiTy of Life (AFEQT), an instrument specific to AF, both with range 0-100 and higher scores indicating superior outcomes.