• Sudarshan Krishnamurthy, Yaming Li, Florentina Sileanu, Utibe R Essien, Megan E Vanneman, Maria Mor, Michael J Fine, Carolyn T Thorpe, Thomas Radomski, Katie Suda, Walid F Gellad, and Eric T Roberts.
• Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
• J Gen Intern Med. 2024 Sep 1; 39 (12): 224922602249-2260.

BackgroundPrior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner.ObjectiveTo examine differences in Veterans' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021.DesignObservational analyses of Veterans' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors.ParticipantsRespondents to the 2016-2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey.MeasuresCare ratings in nine domains.Key ResultsThe sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from - 0.04 to - 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted.ConclusionsThis study identified small but persistent racial and ethnic differences in Veterans' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans' patient experience could advance equity in VA community care.© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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