Interventions to Reduce Racial and Ethnic Disparities in Health           Care

Chin, Marshall H.; Walters, Amy E.; Cook, Sandy; Huang, Elbert S.

doi:10.1177/1077558707305413

Cited by 271 publications

(231 citation statements)

References 29 publications

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“…26,27 We found that most primary-care clinicians endorsed the collection of patients' race and ethnicity data to improve the quality of diabetes care, concordant with regulations in other settings that require hospitals to collect these self-reported data. 28 Whereas the vast majority recognized the existence of racial disparities within the U.S. health system, only slightly more than one third acknowledged their presence among patients they personally treat.…”

Section: Discussionmentioning

confidence: 84%

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

et al. 2008

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BACKGROUND: Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. OBJECTIVE:The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. DESIGN:The design of the study is through a survey of primary-care clinicians (response rate=86%). PARTICIPANTS:The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. MEASUREMENTS AND MAIN RESULTS:We identified sociodemographic characteristics of each clinician's diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients' race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients' race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2-65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5-57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). CONCLUSIONS:Most primary-care clinicians support the collection of data on patients' race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients. INTRODUCTIONRacial disparities in the quality of diabetes care are persistent across all sectors of the U.S. health care system. Black patients with diabetes are less likely than white patients to receive appropriate hemoglobin A1c and lipid testing 1,2 and less likely to achieve treatment goals including glycemic, cholesterol, and blood pressure control. [3][4][5][6][7][8] Blacks also experience worse long-term diabetes-related outcomes than whites, including diabetic retinopathy, 9 lower extremity amputations, 2,10,11 and chronic kidney disease. 12 Hispanics and Native Americans have also been found to receive lower-quality diabetes care, with Native Americans experiencing disproportionately high rates of lower extremity amputations, chronic kidney disease, and diabetes-related mortality. 2,[13][14][15][16][17] The etiology of these racial disparities is multifactorial involving health system, provider, and patient factors, all within the context of broader social issues. 18 Physicians can play an important role in addressing racial disparities in care through their direct interface with patients and the health care system. For example, clinica...

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Section: Discussionmentioning

confidence: 84%

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

et al. 2008

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“…In mental health, however, little is known about the equity effects of quality improvement interventions (7), and most studies of these effects have focused on depressed populations (8,9). A review of quality improvement interventions for patients with depression and other chronic health conditions identified case management as a key ingredient of multicomponent approaches that improved quality and reduced disparities (10). …”

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confidence: 99%

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

Horvitz-Lennon

Zhou²,

Normand³

et al. 2011

Psychiatric Services

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Objective Case management–based interventions aimed at improving quality of care have the potential to narrow racial and ethnic disparities among people with chronic illnesses. The aim of this study was to assess the equity effects of assertive community treatment (ACT), an evidence-based case management intervention, among homeless adults with severe mental illness. Methods This study used baseline, three-, and 12-month data for 6,829 black, Latino, and white adults who received ACT services through the ACCESS study (Access to Community Care and Effective Services and Support). Zero-inflated Poisson random regression models were used to estimate the adjusted probability of use of outpatient psychiatric services and, among service users, the intensity of use. Odds ratios and rate ratios (RRs) were computed to assess disparities at baseline and over time. Results No disparities were found in probability of use at baseline or over time. Compared with white users, baseline intensity of use was lower for black users (RR=.89; 95% confidence interval [CI]=.83–.96) and Latino users (RR=.65; CI=.52–.81]). Intensity did not change over time for whites, but it did for black and Latino users. Intensity increased for blacks between baseline and three months (RR=1.11, CI=1.06–1.17]) and baseline and 12 months (RR=1.17, CI=1.11–1.22]). Intensity of use dropped for Latinos between baseline and three months (RR=.83, CI=.70–.98). Conclusions Receipt of ACT was associated with a reduction in service use disparities for blacks but not for Latinos. Findings suggest that ACT’s equity effects differ depending on race-ethnicity.

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“…The average DB score of 213 studies included in the first set of systematic reviews commissioned by the Robert Wood Johnson foundation was 17.65 out of a maximum of 27 point (the scoring instrument used in these reviews excluded the power item and Cochrane-derived bias item). 21 Initial ratings for this review were conducted by the first four authors and two trained research assistants, using a Microsoft Access database designed for this symposium to calculate the DB score for each study. As a quality control measure, 20 % of studies were re-scored by the final author, and the inter-rater agreement for quality score using the modified DB tool was adequate (κ=0.67).…”

Section: Quality Assessmentmentioning

confidence: 99%

HIV Prevention Interventions to Reduce Racial Disparities in the United States: A Systematic Review

et al. 2012

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Racial and ethnic minorities are disproportionately affected by HIV/AIDS in the United States despite advances in prevention methodologies. The goal of this study was to systematically review the past 30 years of HIV prevention interventions addressing racial disparities. We conducted electronic searches of Medline, PsycINFO, CINAHL, and Cochrane Review of Clinical Trials databases, supplemented by manual searches and expert review. Studies published before June 5, 2011 were eligible. Prevention interventions that included over 50 % racial/ethnic minority participants or sub-analysis by race/ethnicity, measured condom use only or condom use plus incident sexually transmitted infections or HIV as outcomes, and were affiliated with a health clinic were included in the review. We stratified the included articles by target population and intervention modality. Reviewers independently and systematically extracted all studies using the Downs and Black checklist for quality assessment; authors cross-checked 20 % of extractions. Seventy-six studies were included in the final analysis. The mean DB score was 22.44 – high compared to previously published means. Most of the studies were randomized controlled trials (87 %) and included a majority of African-American participants (83 %). No interventions were designed specifically to reduce disparities in HIV acquisition between populations. Additionally, few interventions targeted men who have sex with men or utilized HIV as a primary outcome. Interventions that combined skills training and cultural or interactive engagement of participants were superior to those depending on didactic messaging. The scope of this review was limited by the exclusion of non-clinic based interventions and intermediate risk endpoints. Interactive, skills-based sessions may be effective in preventing HIV acquisition in racial and ethnic minorities, but further research into interventions tailored to specific sub-populations, such as men who have sex with men, is warranted.

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Interventions to Reduce Racial and Ethnic Disparities in Health Care

Cited by 271 publications

References 29 publications

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Racial and Ethnic Service Use Disparities Among Homeless Adults With Severe Mental Illnesses Receiving ACT

HIV Prevention Interventions to Reduce Racial Disparities in the United States: A Systematic Review

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