An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD

Chen, Jie; Buchongo, Portia; Spencer, Merianne Rose; Reynolds, III Charles F.

doi:10.1016/j.jagp.2022.04.010

Cited by 9 publications

(4 citation statements)

References 55 publications

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“…Resources can be directed toward SDOH to improve the well-being of older adults. Our findings were also consistent with the structural racism and discrimination (SRD) literature and supported the framework of SRD patients with ADRD [30][31][32][33][34] . The components of SRD, such as institutional racism, systemic barriers, and other health determinants, are key factors to target to decrease disparities.…”

Section: Jama Network Open | Health Policysupporting

confidence: 90%

Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

Albaroudi

Chen

2022

JAMA Netw Open

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ImportanceConsumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD).ObjectiveTo examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities.Design, Setting, and ParticipantsThis study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022.ExposureEnrollment in a Medicare Shared Savings Program ACO.Main Outcomes and MeasuresSix ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients’ rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others.ResultsThe final sample included 568 368 beneficiaries (347 783 female patients [61.2%]; 38 030 African American patients [6.69%], 6258 Asian patients [1.10%], 18 231 Hispanic patients [3.21%], and 505 849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = −1.05; 95% CI, −1.15 to −0.95; P &lt; .001), Asian (coefficient = −0.414; 95% CI, −0.623 to −0.205; P &lt; .001), and Hispanic (coefficient = −0.099; 95% CI, −0.229 to 0.032; P = .14) patients with ADRD reported lower total CAHPS scores. Disparities were also observed among individual ACO CAHPS. Decomposition results showed that a proxy for social determinants of health explained 10% to 13% of disparities of ACO CAHPS between African American or Black vs White and Hispanic vs White patients with ADRD. Most of the racial and ethnic disparities, especially those between White and Asian individuals, could not be explained by the models used to analyze data.Conclusions and RelevanceThese results demonstrated significant variations in CAHPS by race and ethnicity among patients with ADRD enrolled in ACOs. Social determinants of health are critical in explaining racial and ethnic disparities. More research is needed to explain disparities in CAHPS.

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Section: Jama Network Open | Health Policysupporting

confidence: 90%

Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

Albaroudi

Chen

2022

JAMA Netw Open

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Section: Discussionmentioning

confidence: 99%

“…They did not address specific elements related to discrimination or attempt to address experiences of bias. Interventions in other healthcare fields which target structural and interpersonal aspects of healthcare quality for Blacks have improved engagement in care and clinical outcomes(Chen et al, 2022).Only one intervention reviewed in this study provided supportive care to address structural inequities experienced by Black pregnant and post-partum people, such as transportation and childcare(Klerman et al, 2001). Integrated, supportive care interventions, inclusive of support persons and services, improve healthcare engagement and perceived quality of care(McLeish & Redshaw, 2019;Wint et al, 2019).…”

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confidence: 96%

A scoping review of interventions seeking to improve aspects of patient–provider relationships involving Black pregnant and post‐partum people

Alexander

Clary-Muronda

2022

Journal of Advanced Nursing

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Aims: To provide a map of the evidence related to interventions targeting patientprovider relationships among Black perinatal people. Design: A scoping review of the literature was conducted. Data Sources: The database search included English language articles within three databases: PubMed, the Cumulative Index for Nursing and Allied Health Literature, and Medline without date restriction on June 15 and16 2022. Review Methods: This scoping review used the six-stage process first described by Arksey and O'Malley and recommended by the Joanna Briggs Institute: (1) specify the research question, (2) identify relevant literature, (3) select studies, (4) map out the data, (5) synthesize, and report the results and (6) consult experts. Studies were included if they (1) reported results of intervention studies related to patient-provider interaction, (2) were written in English and (3) were original research. The articles were reviewed with content analysis methodology to categorize and interpret the findings. Results: Studies included randomized controlled trials (n = 5) and qualitative studies (n = 3) published between 2001 and 2018. Black pregnant people made up more than half of the participants in five of the eight studies (63%). Interventions were divided into three categories: delivery models (n = 4), mHealth risk assessment tools (n = 2) and patient-provider communication tools (n = 2). Conclusion: This study addressed the unknown role of patient-provider relationship interventions in improving the quality of care received by Black perinatal people. Findings suggest that structural and interpersonal components may have the potential to improve outcomes for Black pregnant people but could be further improved if culturally tailored. Further research is urgently needed to address discrimination and stigma in patient-provider relationships. The findings of this study could inform novel intervention development and should drive research. Impact: A scoping review determined that there are no interventions with Black pregnant people which targeted discrimination and bias in patient-provider relationships.

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“…While HIT can improve efficiency, Black and Hispanic patients with ADRD have less access to HIT-integrated health care systems compared with their Non-Hispanic White counterparts 22,23. A recent study delineated a conceptual framework for racial and ethnic disparities in ADRD care and discussed how the HIT-supported care coordination model could reduce structural racism and discrimination (eg, racial residential segregation and structural barriers in health care) for patients with ADRD 24. Building on that model, this present study provided empirical evidence on the association between the HIT infrastructure and racial and ethnic disparities in health care costs among patients with ADRD.…”

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confidence: 99%

Hospital-based Health Information Technology Infrastructure

Chen¹,

Spencer²,

Buchongo³

et al. 2022

Medical Care

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Background: Alzheimer disease and related dementia (ADRD) is one of the most expensive health conditions in the United States. Understanding the potential cost-savings or cost-enhancements of Health Information Technology (HIT) can help policymakers understand the capacity of HIT investment to promote population health and health equity for patients with ADRD. Objectives: This study examined access to hospital-based HIT infrastructure and its association with racial and ethnic disparities in Medicare payments for patients with ADRD. Research Design: We used the 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Association Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries who were diagnosed with ADRD. Our study focused on hospital-based telehealth-postdischarge (eg, remote patient monitoring) and telehealth-treatment (eg, psychiatric and addiction treatment) services. Results: Results showed that hospital-based telehealth postdischarge services were associated with significantly higher total Medicare payment and acute inpatient Medicare payment per person per year among patients with ADRD on average. The associations between hospital-based telehealth-treatment services and payments were not significant. However, the association varied by patient’s race and ethnicity. The reductions of the payments associated with telehealth postdischarge and treatment services were more pronounced among Black patients with ADRD. Telehealth-treatment services were associated with significant payment reductions among Hispanic patients with ADRD. Conclusion: Results showed that having hospital-based telehealth services might be cost-enhancing at the population level but cost-saving for Black and Hispanic patients with ADRD. Results suggested that personalized HIT services might be necessary to reduce the cost associated with ADRD treatment for racial and ethnic minority groups.

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An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD

Cited by 9 publications

References 55 publications

Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias

A scoping review of interventions seeking to improve aspects of patient–provider relationships involving Black pregnant and post‐partum people

Hospital-based Health Information Technology Infrastructure

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