Health Services Research Commons^™

Hispanic Ethnicity Is Associated With Increased Hospital Charges After Radical Cystectomy In The United States, Mark D. Tyson, Erik P. Castle

Journal of Health Disparities Research and Practice

Objective: To examine the impact of race and ethnicity on financial charges associated with radical cystectomy (RC).

Data Sources/Study Setting: The Nationwide Inpatient Sample was used to identify patients who underwent RC for bladder cancer between 1998 and 2010.

Study Design: The primary outcome was total hospital charges adjusted for inflation. Multivariate analysis was performed using a generalized linear model on the logarithmically transformed outcome variable (total hospital charges) after adjusting for age, sex, race, Elixhauser comorbidities, surgical approach, year, primary payer, hospital and surgeon annual RC volume, hospital characteristics, and postoperative complications.

Principle findings: A total of 14,873 patients …

Evaluation Of The Nci’S Community Cancer Centers’ Program (Ncccp): Impact On Disparities In Quality Of Cancer Care, Michael T. Halpern, Pamela Spain, Debra J. Holden, Andrew K. Stewart, Erica J. Mcnamara, Greer Gay, Steven B. Clauser, Irene Prabhu Das

Journal of Health Disparities Research and Practice

This study examined the effects of the NCCCP pilot on breast or colon cancer quality of care for patients from underserved populations and those treated at disparities-focused hospitals (NCCCP sites having fewer oncology resources or in communities with greater proportions of underserved populations). Data on five quality of care measures were collected using the Commission on Cancer’s Rapid Quality Reporting System. Following NCCCP initiation, we observed improvements in all five quality of care measures. There were similar quality of care improvements for Black vs. White patients, privately insured vs. Medicaid or uninsured patients, and men vs. women. Patients treated at …

American Muslim Health Disparities: The State Of The Medline Literature, Aasim I. Padela, Afrah Raza

Journal of Health Disparities Research and Practice

Background: While religious beliefs and values influence health behaviors, conventional health disparities research rarely examines health outcomes by religious affiliation particularly within multi-ethnic minority communities.

Methods: Using a systematic strategy we searched the Medline literature to identify empiric studies that report on health disparities between American Muslims and non-Muslim groups residing in America. In addition to use religious affiliation descriptors for Muslim groups we utilized geographic and ethnicity terms such as “South Asian” or “Pakistani” as proxy terms to help uncover studies of American Muslims.

Results: 171 empirical studies were captured. South Asians and Arabs were the most commonly studied …

Health Literate Organizations: Are Clinical Trial Sites Equipped To Recruit Minority And Limited Health Literacy Patients?, Jennifer Livaudais-Toman, Nancy J. Burke, Anna Napoles, Celia P. Kaplan

Journal of Health Disparities Research and Practice

Background. Racial/ethnic minority patients are less likely than non-Latino white patients to participate in cancer clinical trials. A key barrier to participation is limited health literacy which is more common among minorities. At the organizational level, it is important that clinical trials sites become better equipped to recruit minority patients by expanding their organizational health literacy including language competency and outreach efforts. We explored the characteristics of clinical trial sites that are associated with these health literate behaviors.

Methods. We identified 353 breast clinical trials recruiting participants in 2006 from four states (California, Florida, Illinois, and New York) through the …

Association Analysis Of Reported Attitudes And Culturally Competent Behavior Engagement Among Public Health Department Employees, Marla B. Hall Phd, Jeffrey J. Guidry Phd, E. Lisako Mckyer Phd, Corliss Outley Phd, Danny Ballard Phd

Journal of Health Disparities Research and Practice

Objective: The purpose of this research is to analyze the association of attitudes and beliefs on engaging in culturally competent behavior.

Design: Explorational case study of individuals employed within an urban public health department.

Participants: Employees (n=90) from four metropolitan clinical sites of an urban public health department located in the southwest region of the United States were solicited and recruited during a monthly staff meeting. This sample is representative of 84% of the total employees which is comprised of 107 individuals.

Main Outcome Measures: The Cultural Competence Assessment is designed to explore individual knowledge, feelings …

Discrimination In Medical Settings And Attitudes Toward Complementary And Alternative Medicine: The Role Of Distrust In Conventional Providers, Tetyana Shippee, Carrie Henning-Smith, Nathan Shippee, Jessie Kemmick Pintor, Kathleen T. Call, Donna Mcalpine, Pamela Jo Johnson

Journal of Health Disparities Research and Practice

This study examines the relationship between racial/ethnic discrimination in medical settings, distrust in conventional medicine, and attitudes toward complementary and alternative medicine (CAM) among a racially/ethnically diverse sample. We also investigate how this relationship differs by nativity. Data are from a 2008 statewide stratified sample of publicly insured adults in Minnesota (N=2,194). Discrimination was measured as self-reported unfair treatment in medical settings due to race, ethnicity, and/or nationality. Outcomes are trust in conventional providers/medicine and attitudes toward CAM modalities. Discrimination in medical settings was positively associated with 1) distrust in conventional providers and 2) favorable attitudes toward CAM. Foreign-born …

Emerging Disparities Among Self-Pay Trauma Patients, Michelle Chino Dr, Deborah A. Kuhls, Mark K. Markarian, Sam Holland, John J. Fildes

Journal of Health Disparities Research and Practice

Preliminary results from a study of trauma patients in Southern Nevada are yielding some unexpected findings with implications for both trauma centers and the growing Hispanic population. Hispanic patients are more likely to be self pay irrespective of income level and employment status when compared to non-Hispanic patient groups. Further, self pay Hispanics, unlike their non-Hispanic, self pay counterparts, tend to be employed, have families, and report stable living conditions. The implication is that the financial and social cost of traumatic injury may place a significant burden on trauma centers, patients, their families and the community.

Developing A Preference Assessment Tool For Use Among Minority And Low Literacy Primary Care Patients, Sarah T. Hawley, Maria Jibaja-Weiss, Partha Krishnamurthy, Sally W. Vernon, Natoshia Hebert, Robert Volk

Journal of Health Disparities Research and Practice

Incorporating patients’ preferences into healthcare decisions has been identified as one mechanism for reducing health disparities. Some research suggests that providers need to tailor medical recommendations to the preferences of their patients. Yet there are few tools to facilitate clarification of preferences for health services. This paper reports the process of testing an innovative preference elicitation technique—conjoint analysis—among minorities and low literacy patients using the example of colorectal cancer (CRC) screening. CRC screening exemplifies preference-sensitive healthcare as there exist several screening options. However, screening rates among minorities are low. Better methods for preference assessment could improve patient-provider communication and increase …

Physicians’ Experiences And Opinions Regarding Strategies To Improve Care For Minority Patients, Jared W. Klein, Lindsay O. Schubiner, Margaret Gadon, Matthew K. Wynia

Journal of Health Disparities Research and Practice

Objective: To assess the views and experiences of a select group of physicians interested in minority health issues regarding promising strategies to improve minority care. Methods: Physicians were asked to respond to a 17-item survey assessing the level of agreement, frequency of implementation of and interest in learning more about 7 promising strategies for alleviating disparities. Results: Most physicians (75-95%) agreed that the 7 proposed strategies could be useful to improve the quality of care provided to minority patients, but only 40-66% of physicians had implemented the strategies sometimes or often in their practices. Between 22 and …

Racial Disparities In Cancer Screening Among Women With Chronic Joint Pain, Edith M. Williams, Laurene Tumiel-Berhalter, Christopher Purdy, Adrianne Ransom, Judith Anderson

Journal of Health Disparities Research and Practice

Chronic pain related disorders and breast and cervical cancer are more prevalent among African-American women compared with non-Hispanic White women. However, few studies address how racial differences in the context of comorbidity may compound these disparities. This study used secondary analysis of the National Health Interview Survey (NHIS) to assess racial differences in breast and cervical cancer screening and patient education among adult women with chronic joint pain conditions. Statistical analyses included chi-square and independent samples t-tests. African-American women compared with non-Hispanic White women were less likely to receive a pap smear or mammogram within the last two years and …

Preventing Hepatitis B-Induced Liver Cancer: Implications For Eliminating Health Disparities, Moon S. Chen Jr.

Journal of Health Disparities Research and Practice

If the definition of eliminating of a health disparity were signified by the absence of any differences in incidence or mortality between a population’s experiences with a health problem, then the only health disparity that has ever been eliminated is smallpox because with zero cases of smallpox in the world, no health disparities exist because of smallpox. The eradication of smallpox is perhaps the only historical example where the elimination of a health disparity has been achieved. Principles and lessons learned, particularly through the intersection of science and policy that could be applied to the elimination of other health disparities …

Perceptions Of Healthcare, Health Status, And Discrimination Among African-American Veterans, Nathaniel Rickles, Silvia Dominguez, Hortensia Amaro

Journal of Health Disparities Research and Practice

The Institute of Medicine identified access to healthcare and race-based discrimination as important barriers to quality healthcare that contributes to health disparities. This study (1) describes African-American veterans’ perceptions of healthcare services and perceived discrimination in healthcare and (2) investigates the relationship between perceived discrimination and patient perceptions of care, satisfaction with healthcare, and health status. A convenience sample of 141 African-American veterans in Boston completed surveys from May to June 2006.

Respondents reported an average of 16 lifetime experiences of discrimination and over half recalled a situation when they experienced discrimination in healthcare. Modest ratings of perceived quality of …

Determinants Of Depressive Symptoms Among Women On Public Assistance In Louisiana, Theresa C. Davidson, Joachim Singelmann

Journal of Health Disparities Research and Practice

Depression can be a significant barrier in the welfare-to-work transition of poor women. Fortunately, support from social networks can lessen symptoms and facilitate entry into the workplace. Inconsistency in the literature concerning the effects of social networks on the poor suggests further research is needed. Thus, we examine the level and determinants of depressive symptoms among participants in the Temporary Assistance to Needy Families program. Having a good job, being in good health, married, and black, and living in rural areas inhibit symptoms of depression. Remaining on TANF and having several children increases symptom levels. Those who report that they …

Multistate Assessment Of Public Health Surveillance Relevant To American Indians And Alaska Natives, 2007, Jeanne Bertolli, Ed Chao, Michael Landen, Eden Wells, John M. Hayes, Zeenat Mahal, Ralph T. Bryan

Journal of Health Disparities Research and Practice

Improving the health of American Indian and Alaska Native (AI/AN) populations involves multiple agencies, levels of government, and jurisdictions. We assessed collaboration between state health departments and AI/AN Tribes and agencies through an online survey of State Epidemiologists. Frequencies and percentages of responses were examined by univariate and bivariate analyses. Among 39 states with federally recognized or state-recognized Tribes or federally funded urban Indian health centers, 25 (64%) participated. Nineteen had discussed public health surveillance with an AI/ AN government or nongovernment entity in the past 2 years (10 (53%) of these had ongoing, regular discussions about public health surveillance; …

Application Of A Re-Aim Framework To Assess The Impact Of The Southwest American Indian Collaborative Network, Michelle Chino, Carolee Dodge Francis

Journal of Health Disparities Research and Practice

In response to a Request for Proposals from the National Cancer Institute (NCI), the Inter Tribal Council of Arizona (ITCA) along with health care partners from the Phoenix Indian medical Center (PIMC) and academic partners from the Arizona Cancer Center (ACC) at the University of Arizona (UA), and the University of Nevada Las Vegas (UNLV) established a Community Network Program entitled the Southwest American Indian Collaborative Network (SAICN). The ultimate goal of the SAICN project was to “eliminate cancer health disparities by closing the gap between the health needs of the community and cancer prevention and control made possible by …

Asthma Management: An Ecosocial Framework For Disparity Research, Robin A. Evans-Agnew

Journal of Health Disparities Research and Practice

Background: Asthma management disparities (AMD) between African and White Americans are significant and alarming. Various determinants have been suggested by research frameworks that affect the unfair distribution of resources for asthma management to groups who are more or less advantaged socially. Ecosocial models organize determinants into individual/family, healthcare, community, and sociocultural levels. Multilevel interventions can affect AMD through simultaneous actions on different levels and pathways between determinants.

Objective: Provide a comprehensive summary of the known determinants of AMD.

Method: Peer reviewed research frameworks of AMD from 1998-2009 were retrieved from PubMed/ Web of Science databases using (“Socioeconomic Factors”[Mesh] OR (“Healthcare …

Race And Hepatitis C Management Within The Veterans Administration, Joahd Toure, Joshua Metlay, Sandford Schwartz, Knashawn Morales, David Kaplan, Peter Groeneveld

Journal of Health Disparities Research and Practice

Objective: To examine black-white differences in hepatitis C treatment within the Veterans Administration (VA) and determine whether racial variation in specialty consultation explains differences in hepatitis C treatment between blacks and whites.

Methods: We performed a retrospective cohort study of 1040 veterans meeting VA eligibility criteria for hepatitis C treatment. We used multiple imputation to handle missing race data. Specialty consultation was determined from the VA outpatient medical dataset and hepatitis C treatment was determined from the VA decision support system. Conditional logistic regression was used to examine the association between race and hepatitis C treatment as well as race …

Results Of Universal Prenatal Screening For Hepatitis C Infection In A Remote American Indian Primary Care Population, Christine Dubray, John T. Redd, Cecile M. Town, Kathy K. Byrd, Supriya Janakiraman, Anindya K. De, James E. Cheek

Journal of Health Disparities Research and Practice

BACKGROUND: Although chronic liver disease remains a major area of health disparity for American Indian (AI) people, the epidemiology of hepatitis C virus (HCV) infection among AI people is poorly documented. Because of suspected high local prevalence, two remote AI clinics in the Northern Plains implemented universal prenatal HCV screening in 2005. When this screening program reported an unexpectedly high prenatal anti-HCV (anti-HCV antibody) positivity rate, we conducted a case-control study to determine risks for infection and opportunities for community intervention.

MAIN FINDINGS: The clinics screened a total of 205 pregnant women (median age, 22 years). Of these 205 women, …

Value Of Community Partnership For Understanding Stress And Coping In Rural Yup’Ik Communities: The Canhr Study, Inna D. Rivkin, Ellen Lopez, Tonie M. Quaintance, Joseph Trimble, Scarlett Hopkins, Candace Fleming, Eliza Orr, Gerald V. Mohatt

Journal of Health Disparities Research and Practice

Stress and trauma can compromise physical and mental health. Rural Alaska Native communities have voiced concern about stressful and traumatic events and their effects on health. The goal of the Yup’ik Experiences of Stress and Coping Project is to develop an in-depth understanding of experiences of stress and ways of coping in Yup’ik communities. The long-range goal is to use project findings to develop and implement a community-informed and culturally grounded intervention to reduce stress and promote physical and mental health in rural Alaska Native communities. This paper introduces a long-standing partnership between the Yukon-Kuskokwim Regional Health Corporation, rural communities …