Equity-guided Improvement Strategy Reduces VA Health Care Disparities
VA researchers have long improved the lives of Veterans by identifying disparities in health and health care between populations of Veterans; understanding the factors that underlie those differences; and developing and testing ways to reduce and eliminate them. Today, through its Equity-Guided Improvement Strategy (EGIS), VHA's Office of Health Equity (OHE) is spreading researchers' interventions to reduce disparities throughout the VA health care system.
Researchers know there are large differences in care outcomes (changes in health that result from specific health care investments or interventions) among different populations of Veterans. These differences are often associated with Veterans' sex, race and ethnicity, whether they live in urban or rural areas, and other issues. The differences in outcomes tend to be smaller in VHA than in other health care systems, but still exist. Minority Veterans, for example, have higher rates of chronic illnesses such as diabetes and hypertension.
The goal of EGIS is to identify populations having the biggest challenges to positive outcomes and to deliver customized clinical interventions that will enable these Veterans to live healthier lives. OHE assists VA facilities in reviewing the processes used to provide clinical care to Veterans and supports process improvements that help different groups of Veterans achieve similar outcomes. For example, African-Americans with diabetes can receive either generic, one-size-fits-all interventions or interventions specifically designed to optimize their ability to control their blood glucose levels. VA researchers have learned that matching African-American peer counselors who have gotten their hemoglobin A1C levels under control with patients who have not yet been able to do so achieves better outcomes than when patients are only given generic instructions on diet and exercise.
OHE is creating a system to review data from VA medical centers to determine where significant disparity issues exist and to make that information available through clinical "dashboards" to medical center leaders throughout VA. They will also work with quality management officers to help them learn about and implement available solutions, such as the peer counseling concept described above. Such equity strategies will help facilities improve their quality of care and find areas for improvement where leaders will get the most "bang for the buck."
OHE also regularly provides information about health care equity to VA leadership and health care providers and prepares monthly fact sheets to draw attention to disparities faced by Veterans. This includes disparities of care between Veterans who use VA for health care and those who do not, and between Veterans and non-Veterans.
Impact on Veterans
By helping VHA put research into practice, OHE is reducing health disparities in the care of Veterans who have systematically experienced greater social or economic obstacles to health than others, and making VA a more equitable health care delivery system. Using EGIS, OHE will help VA medical centers provide better health care for Veterans that directly leads to better health outcomes for all Veterans.