This Information Brief highlights research by Dr. Donna Washington and her colleagues at the Health Equity-QUERI National Partnered Evaluation Center on rates of non-communicable diseases – high blood pressure, diabetes, and abnormal cholesterol levels that have lifestyle related risk factors, such as physical inactivity and food choices. The Information Brief also highlights The Battle Creek VA Medical Center Healthier Living with Chronic Conditions (HLCC) workshop series helps to build Veterans’ confidence to self-manage their chronic medical conditions and the San Francisco VA Health Care System’s Strength and Wellness Program and its collaboration with the San Francisco YMCA Association to create a community-based fitness program for Veteran patients.
This Information Brief highlights research by Dr. Donna Washington and her colleagues at the Health Equity-QUERI National Partnered Evaluation Center on rates of heart disease in African American Women Veterans. The Information Brief also highlights videos of Veterans discussing their experiences with high blood pressure offering tips on taking medications, talking to health care providers, and making other healthy behavior changes and the long-standing national partnership between VA and the American Heart Association to bring awareness and knowledge about heart disease and stroke.
This Information Brief highlights research by Dr. Donna Washington and her colleagues at the Health Equity-QUERI National Partnered Evaluation Center on rates of mental health conditions amongst American Indian/Alaska Native Veterans. The Information Brief also highlights the importance of Patient-Centered Medical Homes (PCMHs), which deliver primary care through an integrated, team-based approach, in managing care and addressing social determinants of health and mental health conditions, especially for American Indian/Alaska Native Veterans.
This Information Brief highlights research by Dr. Donna Washington and her colleagues at the Health Equity-QUERI National Partnered Evaluation Center on rates of diabetes amongst Hispanic Veterans. The Information Brief also highlights the OHE-supported project with VA Heart of Texas Health Care Network (VISN 17) that developed and delivered a culturally sensitive MOVE! curriculum aimed to address the specific needs of Hispanic Veterans with diabetes in Texas.
Focus on Health Equity and Action Cyberseminars
VHA's Office of Health Equity is pleased to partner with the VA Center for Minority Veterans for April’s session in observation of National Minority Health Month. April’s Focus on Health Equity and Action Cyberseminar session spotlights the recently released "Minority Veterans Report: Military Service History and VA Benefit Utilization Statistics" report from the VA Data Governance and Analytics office. This new report increases our understanding of racial and ethnic minority Veterans, their use of VA benefits and services, as well as the impact of military service on their lives post-military. April’s session will: 1) discuss the new report and the role of social and economic determinants of health; 2) highlight VA actions to advance health equity for minority Veterans; and 3) explore additional ways to best to serve these American heroes.
Complete, reliable, and consistent measurement of racial and ethnic background in healthcare is critical for valid health equity and disparity studies. However, despite many efforts, missing data on race/ethnicity are common in VA data. The Office of Health Equity partnered with the Health Equity Research Outreach Initiatives Coin (HEROIC) to explore ways for addressing this gap. This Cyberseminar will share the findings with regard to: (1) patient and provider attitudes, challenges and preferences for how to collect race/ethnicity and (2) statistical approaches to address missing race/ethnicity data in the VAMC.
The purpose of the presentation is to share the findings from the evaluation of the VISN 4 quality improvement project to reduce racial disparities in hypertension management. The presentation will 1) highlight the partnership of Office of Health Equity, VISN 4 and CHERP in pursuit of health equity including how the project was conceived, 2) describe the nature and intensity of specific strategies implemented at individual facilities to reduce blood pressure disparities, 3) discuss the barriers and facilitators to implementing specific strategies, and 4) present data regarding the impact of the project on disparities over time. The presentation will conclude with a discussion of recommendations gleaned from the project to guide future quality improvement efforts focused on disparities in health or health care.
The purpose of this session is to discuss the VA journey and crucial partnerships towards eliminating health care disparities. It will highlight collaborations with examples from VHA Office of Health Equity, CHERP and HEROIC towards this goal. This Cyberseminar is part of the VA Center for Minority Veterans 20th anniversary events.
VA Research Publications
- Breland, J. Y., Phibbs, C. S., Hoggatt, K. J., Washington, D. L., Lee, J., Haskell, S., Uchendu, U. S., Saechao, F. S., Zephyrin, L. C., Frayne, S. M. (2017). The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans. Journal of General Internal Medicine.
- Loganathan, S. K., Hasche, J. C., Koenig, K. T., Haffer, S. C., Uchendu, U. S. (2017). Racial and Ethnic Differences in Satisfaction with Care Coordination Among VA and non-VA Medicare Beneficiaries. Health Equity, 1(1): 50-60.
- Washington DL, Steers WN, Huynh AK, Frayne SM, Uchendu US, Riopelle D, Yano EM, Saechao FS, Hoggatt KJ. (2017). Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes. Health Affairs, 36(6):1086-1094.
- Lynch, J., Whatley, A., Uchendu, U. S., Ibrahim, S. A. (2014). Race and Genomics in the Veterans Health Administration. American Journal of Public Health, 104(S4): S522-S524.
- Tsai, J., Whealin, J. M., Pietrzak, R. H. (2014). Asian American and Pacific Islander Military Veterans in the United States: Health Service Use and Perceived Barriers to Mental Health Services. American Journal of Public Health, 104(S4): S538-S547.
- Noe, T. D., Kaufman, C. E., Kaufmann, J., Brooks, E., Shore, J. H. (2014). Providing Culturally Competent Services for American Indian and Alaska Native Veterans to Reduce Health Care Disparities. American Journal of Public Health, 104(S4): S548-S554.
- Backus, L. I., Belperio, P. S., Loomis, T. P., Mole, L. A. (2014). Impact of Race/Ethnicity and Gender on HCV Screening and Prevalence Among US Veterans in Department of Veterans Affairs Care. American Journal of Public Health, 104(S4): S555-S561.
- Samuel, C. A., Landrum, M. B., McNeil, B. J., Bozeman, S. R., Williams, C. D., Keating, N. L. (2014). Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care. American Journal of Public Health, 104(S4): S562-S571.
- Burgess, D. J., van Ryn, M., Noorbaloochi, S., Clothier, B., Taylor, B. C., Sherman, S., Joseph, A. M., Fu, S. S. (2014). Smoking Cessation Among African American and White Smokers in the Veterans Affairs Health Care System. American Journal of Public Health, 104(S4): S580-S587.
- Copeland, L. A., McIntyre, R. T., Stock, E. M., Zeber, J. E., MacCarthy, D. J., Pugh, M. J. (2014). Prevalence of Suicidality Among Hispanic and African American Veterans Following Surgery. American Journal of Public Health, 104(S4): S603-S608.
- Asvat, Y., Cao, D., Africk, J. J., Matthews, A., King, A. (2014). Feasibility and Effectiveness of a Community-Based Smoking Cessation Intervention in a Racially Diverse, Urban Smoker Cohort. American Journal of Public Health, 104(S4): S620-S627.
Health Disparities Evidence-based Synthesis Reviews
- Evidence Brief: Update on Prevalence of and Interventions to Reduce Racial and Ethnic Disparities within the VA--2015
- Health Disparities in Quality Indicators of Healthcare Among Adults with Mental Illness--2014
VA Health Services Research & Development Publication BriefsThe VA Health Services Research and Development Service (HSR&D) pursues research that underscores all aspects of VA healthcare: patient care, care delivery, health outcomes, cost, and quality.
- Evidence Review Identifies Modest Mortality Disparities among Racial and Ethnic Minority Groups in VA Healthcare
To support VA's efforts to better understand the scale and determinants of disparities in racial and ethnic mortality and to develop interventions to reduce disparities, investigators from the VA Evidence-based Synthesis Program (ESP) Coordinating Center in Portland, OR conducted an evidence review of mortality disparities specific to VA. Findings showed that although VA's equal access healthcare system has reduced many racial/ethnic mortality disparities still present in the private sector, modest mortality disparities persist mainly for black Veterans with conditions that include: stage 4 chronic kidney disease, colon cancer, diabetes, HIV, rectal cancer, and stroke (March 1, 2018).
- Racial/Ethnic and Gender Variations in Veteran Satisfaction with VA Healthcare
This study of Veterans' satisfaction with outpatient, inpatient, and specialist care in a diverse sample of Veterans from predominantly minority-serving VAMCs sought to better understand racial/ethnic and gender variations in healthcare satisfaction (March 1, 2018).
External Research and Reports
Journeys with High Blood PressureDid you know that some Veterans, including some racial and ethnic minorities, experience higher rates of hypertension? A VA research team created a series of videos of patients discussing their experiences with high blood pressure and offering tips to take medications, talk to their health care providers, and make other changes. According to the 2016 study, Veterans who watched the videos, compared to those who did not watch the videos, reported greater intentions to:
- Become more physically active;
- Use salt substitutes;
- Talk openly with their doctor about hypertension; and
- Remember to take their hypertension medications.
Module 1 - Journeys with High Blood Pressure
Natasha, an Army Veteran who served for 7 years and worked as a medic, highlights the importance of managing high blood pressure in the African American community. Natasha introduces five African American Veterans who successfully manage their blood pressure. As these Veterans share their stories, Natasha reflects on key factors in their journeys that may help you.
Born and raised in Charleston, South Carolina, Danny shares how the eating habits he developed growing up in the South and while serving in the military lead to his weight gain as a retiree since he no longer exercised daily like a soldier. Eventually, Danny had an episode of blurred vision, was admitted to the emergency room and was diagnosed with high blood pressure. Learn how this Veteran took small steps to get and keep his blood pressure at a normal level. According to Danny, “if you want to live, you can do it.”
Trained as a U.S. Army artillery gunner, Morris travelled many places during his military career after growing up in the small town of Brunson, South Carolina. As an adult, Morris experienced a four day headache that sent him to the emergency room. He learned he had high blood pressure. His heavy drinking made it difficult to control his blood pressure even with medication. Morris shares how the deaths of close family and friends made him stop drinking alcohol and change his eating habits. Now, he is known as the “food inspector” who helps those close him eat healthy.
Patricia grew up in Chicago and joined the military along with two of her friends the year her mother died. Years later, she was diagnosed with high blood pressure. Patricia refused to take her medication because she did not like the side effects. A friend who ended up on kidney dialysis due to high blood pressure convinced Patricia to take her medication daily, as prescribed. Learn what Patricia does to manage her high blood pressure in addition to taking her medication.
VA National PartnersThe Office of Health Equity is committed to working closely with our VA colleagues to ensure that Veterans receive appropriate individualized health care in a way that eliminates disparate health outcomes and assures health equity. OHE's VA Partners include:
- VA Center for Minority Veterans
- VA Office of Diversity & Inclusion
- VHA Office of Health Equity - QUERI National Partnered Evaluation Center
External PartnersThe Office of Health Equity is committed to working closely with other government agencies and non-governmental organizations to ensure that Veterans receive appropriate individualized health care in a way that eliminates disparate health outcomes and assures health equity. OHE's External Partners include:
Cultural Competence Training
- VA Office of Diversity and Inclusion Training Resources
- US Department of Health and Human Services Think Cultural Health Education Programs
- Health Resources and Services Administration Culture, Language, and Health Literacy Resources
VHA Providers Explore Unconscious BiasVHA providers share their stories of creating awareness of unconscious bias within their clinical practice and how bias impacts us all. A bias is a tendency. Most biases are natural. However, biases can cause problems when we are not aware of them and we apply them inappropriately to our everyday choices, which can lead to discriminatory practices and result in poorer health outcomes and experiences for patients. The brief videos were created by the VA Office of Health Equity and Employee Education System in an effort to ensure all Veterans receive high quality and equitable healthcare. The videos were recorded April 2013.
- Developing Clinical Awareness (3:44)
- Impact on Clinical Practice (3:15)
- Importance of Knowing Your Own Bias (3:37)
- Health Equity Stories to Share (6:15)
Harvard Implicit Associations TestThe Implicit Association Test measures attitudes and beliefs that people may be unwilling or unable to report. This tool may be especially interesting if it shows that you have an implicit attitude that you did not know about.
FDA Clinical Trial Diversity Educational Series