|
BACKGROUND/RATIONALE:
Obesity and its health sequelae are increasingly serious concerns in the Veterans Affairs Healthcare System, where it is estimated that 1 in 3 patients is obese and more than 2 in 3 are overweight. While disparities by race are well-documented for many aspects of healthcare, there are strong reasons to believe that similar mechanisms-relating to patient and physician factors-may also lead to differential care by weight status.
OBJECTIVE(S):
We will investigate weight status disparities in quality of care by using a rich array of clinical data obtained from detailed chart abstraction by professional reviewers. First, we will investigate the influence of patient weight status on quality of care using a broad array of process-based measures. We hypothesize that those who are obese receive lower quality of care relative to normal weight patients. Process measures will include diabetes care, cancer screening, and other measures of primary care. Second, we will investigate how patient race/ethnicity moderates the relationship between weight status and quality of care. We also consider the extent to which any racial disparities in care can be explained by differences in patient weight statuses. Third, we will investigate how patient medical complexity influences the relationship between weight status and quality of care. Obese patients may have more complicated overall care. Though we use measures of quality that are not contingent on patient comorbidities, such complexity may distract providers from complying with recommended care, particularly preventive care. Fourth, we will investigate the influence of patient weight status on provider-patient communication quality. Provider bias or stereotyping, along with patients' perceptions of differential treatment, may have a negative influence on quality of communication. We also will consider what role such communication quality plays in the relationship between weight status and quality of clinical care.
METHODS:
We will integrate national-level data from three different sources to address our aims: (1) the VHA Performance Measurement System and External Peer Review Program (EPRP); (2) the VHA Survey of Healthcare Experiences of Patients (SHEP); and (3) VHA administrative data. The EPRP data provides information on measured patient weight status and a variety of key measures on quality of care. We will use process-based measures of care that focus directly on provider activity and do not require risk-adjustments. The SHEP provides data on provider-patient communication quality as well as data on sociodemographic variables such as self-reported race/ethnicity. Lastly, we will use VA administrative data to construct indices of medical complexity using the DCG-HCC system. Analyses will model quality of care for individual process measures as well as overall quality based on a variety of measures.
FINDINGS/RESULTS:
Analyses are in progress at this time. Preliminary results suggest that weight status is inversely associated with success on several individual measures of outpatient processes of care.
IMPACT:
Though the prevention of obesity is a nation-wide public health priority, the vast majority of patients in the VA Healthcare System are already overweight or obese, so it is equally (if not more) vital to ensure that these patients are receiving equitable and effective treatment.
Secular trends suggest that the proportion of patients for whom obesity is a complicating factor to the primary illness will only grow higher in the years to come.
Recent research suggests that patient complexity is positively associated with quality of care. Our study will consider whether this is true among obese patients.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
Quality of Care, Communication and Decision Making
Keywords:
Communication -- doctor-patient, Practice patterns, Obesity
MeSH Terms:
none
|
