# Mitigating Racial/Ethnic and Socio-Economic Disparities in VA Care Quality and Patient Experience

> **NIH VA I01** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2021 · —

## Abstract

Background/Rationale: Black-White disparities in control of hypertension and diabetes contribute to U.S.
racial disparities in life expectancy. Within VA, higher rates of uncontrolled hypertension or diabetes have been
identified in several racial/ethnic minority groups, compared with white Veterans. The extent to which socio-
economic status (SES)-related differences drive these racial-ethnic disparities is unknown. Patient Aligned
Care Teams (PACT) hold promise as a care delivery model to reduce disparities, however, implementation is
variable, particularly in sites with large proportions of minorities. Though traditional medical models cannot
directly change most social determinants of health like SES, facilities can adapt their delivery approaches to
better meet the needs and healthcare delivery preferences of their patients, e.g., incorporating evidence-based
interventions associated with improved hypertension or diabetes control in vulnerable groups, and in that way
influence outcomes indirectly. Appraisal of multi-level factors (healthcare system, site, patient) associated with
improved outcomes in vulnerable groups (racial/ethnic minorities and the lowest quintile SES), and elucidation
of implementation barriers, may inform VA strategies for tackling low quality and ameliorating high disparities.
Specific Aims:
Aim #1: Characterize associations between vulnerable group and quality (measured by intermediate clinical
outcome quality measures hypertension and diabetes control): (a) Determine variations by race/ethnicity and
SES in hypertension and diabetes care quality; (b) Examine SES as a mediator and moderator of the
relationship between race/ethnicity and quality; and (c) Identify multi-level predictors of quality and disparities.
Aim #2: Identify VA sites representing extremes in vulnerable group quality and disparities – high quality-low
disparity “positive deviant” sites, high disparity sites (high quality for majority groups, low quality for vulnerable
groups), and low performing sites (low quality for both majority and vulnerable groups) – and describe
characteristics of those sites.
Aim #3: Compare positive deviant, high disparity, and low performing sites: (a) Assess clinical practice delivery
arrangements for hypertension and diabetes care, particularly evidence-based approaches associated with
disparities reduction, and contextual factors identified in Aim #1; and (b) Identify barriers to and facilitators of
effective implementation of those delivery arrangements.
Methods: We propose a mixed-methods observational study using primary and secondary data sources to
achieve these aims. For Aims #1 and #2, we will use a national cohort of all Veterans using VA in fiscal year
2017, with their individual socio-demographics, diagnosed conditions, and residential characteristics linked with
existing data on VA site and healthcare system characteristics, including site-level PACT implementation and
healthcare system-level patient experien...

## Key facts

- **NIH application ID:** 10197055
- **Project number:** 5I01HX002515-03
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** DONNA WASHINGTON
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10197055

## Citation

> US National Institutes of Health, RePORTER application 10197055, Mitigating Racial/Ethnic and Socio-Economic Disparities in VA Care Quality and Patient Experience (5I01HX002515-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10197055. Licensed CC0.

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