VA Research works to improve health equity among a diverse Veteran population

The demographics of U.S. Veterans are set to change dramatically. Currently, the majority of Veterans are male and white, with the largest group having served during the Vietnam War. However, by 2040, 20 percent of Veterans will be women and 34 percent will be nonwhite.

In a recent article in Veterans Affairs & Military Medicine Outlook, writer Craig Collins looked at the research VA is conducting to help make sure these growing Veteran populations are receiving the same quality of care.

As Collins explains, minority groups are at risk of receiving lower-quality medical care or having worse medical outcomes than the majority. In response to this, the Institute of Medicine (since renamed the National Academy of Medicine) established six aims for the nation’s health care system. These aims are for medical care to be (1) safe, (2) effective, (3) patient-centered, (4) timely, (5) efficient, and (6) equitable.

To address these aims, VA researchers led by Dr. Amy Kilbourne published a conceptual framework of health disparity research in 2006. The framework outlined three phases for research: detection, understanding, and reduction/elimination. First, VA needs to know what disparities exist. Once researchers have identified problem areas, they can try to explain what causes the disparities. These explanations may include patient-level causes such as patient belief, biology, and demographic characteristics; provider-level causes such as bias or communication differences; institutional factors ingrained into policies or practices; and social and environmental factors outside of the health care system. Once researchers have identified the possible causes of disparity, they can work on ways to reduce or eliminate the problems.

Case in point: Joint replacement among minorities

VA has instituted numerous programs aimed at improving health equity. One such program highlighted by Collins is led by Dr. Said Ibrahim of the Corporal Michael J. Crescenz VA Medical Center in Philadelphia. Ibrahim’s research focuses on racial disparities in knee and hip replacement surgery for osteoarthritis. The surgery is elective, but is on the rise nationally as the population gets older and osteoarthritis becomes more common. However, Ibrahim and his team found that African-American Veterans were much less likely to have the surgery than non-minority Veterans.

Ibrahim’s research further showed that the difference stemmed from the beliefs of the patients: minority patients were less willing to try joint replacement. The main reason for this was misinformation about the risks and benefits of the surgery. As Ibrahim explains, “They [minority patients] tend to exaggerate [the complications], and they don’t actually have a whole lot of family or friends who have had the procedure, compared to white patients.”

Ibrahim and his team addressed this disparity by educating minority patients before they actually talked to the orthopedic surgeon about knee or hip problems. The team found that giving patients all the information on the risks and benefits of hip or knee replacement increased their likelihood of having the surgery by nearly 85 percent. Preliminary findings appeared in the journal Arthritis and Rheumatism in 2013. Findings from the most recent stage of Ibrahim’s research were published in JAMA Surgery in January 2017.

More questions ahead

While these results are surprising and encouraging, they raise several more questions that will need to be investigated. Why did these patients exaggerate the negative complications of the surgery? Where did the misinformation come from? The answers to these questions are complex, but Ibrahim’s intervention was able to simply address a striking health disparity.

While there is much work to be done, programs such as this are helping to improve equity within the VA health care system. Learn more about VA’s efforts to combat health disparities in Collins’ full article here.

Also visit VA Research’s Health Equity page to read about other work in this area.

About the author: Tristan Horrom is a writer-editor with VA’s Journal of Rehabilitation Research and Development and with VA Research Communications