Utilization Of Lifestyle Intervention Programs By Race And Ethnicity In The Veterans Health Administration

The Veterans Health Administration (VHA) offers a wide range of physical health, mental health, and supportive services. As result, VHA has the unique ability to track usage of lifestyle intervention programs after physician referral. Outside VHA, patients are frequently sent to other facilities to participate in exercise, nutrition counseling, and other supportive programs making evaluation of utilization a challenge. PURPOSE: To evaluate potential race and ethnicity differences in Veteran participation in lifestyle intervention programs after physician referral. METHODS: De-identified data from VHA’s electronic health record (EHR) was used to create a cohort of Veterans who participated in any of the lifestyle intervention programs offered through VHA in fiscal year (FY) 2023. These Veterans were split into the standard race and ethnicity categories: American Indian or Alaska Native (AIAN), Asian, Black or African American, Hispanic or Latino, More Than One Race, Native Hawaiian or Pacific Islander (NHPI), Unknown, or White based on their indicated race and ethnicity in the EHR. Pearson’s chi-squared and odds ratio tests were run on race and ethnicity categories by lifestyle intervention programs. These data were analyzed for statistical significance in R Studio. RESULTS: 307,968 Veterans utilized lifestyle programs across the VHA in FY23. Asian Veterans were 32% less likely to use Complementary and Integrative Health (CIH) than White Veterans, while Black veterans were 26% more likely than White Veterans to use CIH. Similarly, Asian Veterans were 25% less likely to use Health and Wellness Services compared to White Veterans and 38% less likely to participate in Recreation Therapy than White Veterans. NHPI Veterans were 28% more likely than White Veterans to attend group nutrition counseling while they were 12% less likely than White Veterans to do individual nutrition counseling. All race groups were between 21% and 51% more likely to use Geriatrics services than White Veterans. CONCLUSIONS: There are distinct differences in utilization of lifestyle interventions programs by race and ethnicity groups. These results provide important information for providers in terms of outreach to potential participants. These findings may also suggest ways to integrate culturally competent care in these programs.