Retrospective Review of Care for Black/African American Veterans with Multiple Myeloma at the Orlando VA
Authors: Titus Joane , Carilli Allison , Fillmore Nathanael R. 
Published: December 2024

Multiple myeloma is a significant health concern for African Americans, who are known to experience higher incidence rates and worse outcomes compared to other racial/ethnic groups. While the VA healthcare system provides comprehensive care for veterans, including those with multiple myeloma, the recent implementation of community care programs has allowed veterans to seek healthcare services outside the VA while still benefitting from VA as a payor source. It is essential to assess whether this shift to community care has influenced the quality of care received by African American veterans with multiple myeloma.
Previous research has shown that Black/African American veterans diagnosed with multiple myeloma may experience differing care and treatment within the VA system compared to the community. This may include differences in treatment options and modalities, as well as delays in the onset of care, which can affect the mortality, disease progression, and morbidity of these patients. The research objective will be to assess the quality of care for Black/African American veterans with multiple myeloma at the Orlando VA and identify any potential barriers to care.
The primary objective of this study is to compare the quality of care received by African American veterans with multiple myeloma when utilizing community care services versus care provided within the Department of Veterans Affairs (VA) healthcare system. By analyzing various healthcare quality indicators, we aim to determine whether disparities exist in the quality and outcomes of care between these two healthcare settings controlling for access to covered care with VA as payor in all cases.
Our study will be a continuation of the retrospective study “With equal access, African American patients have superior survival compared to white patients with multiple myeloma” using national data from a diverse cohort of African American VA patients diagnosed with multiple myeloma. We will compare two groups: patients who received their care primarily within the VA system and patients who utilized community care services. Quality of care measures timeliness of care, medication regimens, and outcomes such as survival rates and disease progression, will be evaluated and compared between the two groups.
Inclusion criteria will include a diagnosis of multiple myeloma and identification as Black/African American diagnosed between 2005-2015. The primary outcome will be overall survival of Black/African American veterans with multiple myeloma at the Orlando VA. With secondary outcomes including time to diagnosis from referral, time to treatment, lines of therapy, and transplant referral.
The findings from this study will be valuable in understanding the care received by Black/African American veterans with multiple myeloma and identifying any potential areas for improvement. This information can be utilized to inform the timing of treatment options specifically for this patient population and to shape future policies and practices to guarantee that Black/African American veterans with multiple myeloma receive the highest quality of care.
This study has the potential to shed light on potential disparities in the quality of care experienced by African American veterans with multiple myeloma in different healthcare settings while controlling for insurance coverage. The findings may help identify areas for improvement within the VA healthcare system or community care programs, leading to enhanced care and outcomes for this vulnerable patient population.