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Arenson M, Bahorik A, Xia F, Peltz C, Cohen B, Yaffe K. Understanding Racial Disparities in Dementia Prevalence Among Veterans. J Alzheimers Dis 2024:JAD240181. [PMID: 38995788 DOI: 10.3233/jad-240181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Black and Hispanic older adults have greater incidence of Alzheimer's disease and related dementias relative to White adults, but factors underlying these disparities are not well understood, limiting the ability to address them. Objective To determine the impact of demographics, cardiovascular disease (CVD) and risk factors, social determinants of health (SDOH), and neuropsychiatric risk factors on racial/ethnic disparities in dementia risk among Veterans. Methods We examined a random sample of 1,579,919 older Veterans (age ≥55) without dementia who received care from the VHA from October 1, 1999 to September 30, 2021. All variables were extracted from national VHA data. We used Cox proportional hazard regression models to examine change in variance in risk of dementia across racial/ethnic groups. Results During follow up (mean 11.1 years), 13% of Veterans developed dementia. Relative to White Veterans, the adjusted hazard ratios (AHRs) for developing dementia in sex-adjusted models with age as timescale were 1.65 (95% CI, 1.63-1.67) for Black Veterans and 1.50 (95% CI, 1.44-1.56) for Hispanic Veterans. In the model examining CVD and risk factors, AHRs were 1.53 (95% CI, 1.50-1.55) for Black Veterans and 1.38 (95% CI, 1.33-1.44) for Hispanic Veterans. In the model examining SDOH, AHRs were 1.46 (95% CI, 1.43-1.49) for Black Veterans and 1.34 (95% CI, 1.29-1.40) for Hispanic Veterans. Conclusions SDOH and CVD and risk factors accounted for the greatest amount of variance in racial/ethnic disparities in dementia risk. Cardiovascular disease and SDOH are strong possible targets for interventions designed to reduce these disparities.
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Affiliation(s)
- Melanie Arenson
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
| | - Amber Bahorik
- University of California, San Francisco, San Francisco, CA, USA
| | - Feng Xia
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Carrie Peltz
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Beth Cohen
- University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Healthcare System, San Francisco, CA, USA
| | - Kristine Yaffe
- University of California, San Francisco, San Francisco, CA, USA
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Shanahan ML, Rand KL, Galloway A, Matthias MS. Treatment Goals and Preferences of Black Veterans with Chronic Musculoskeletal Pain. THE JOURNAL OF PAIN 2024; 25:104487. [PMID: 38336030 DOI: 10.1016/j.jpain.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
Understanding patient goals and preferences is critical in the context of complex conditions such as chronic pain. This need may be especially pronounced for Black patients, who experience significant health and healthcare disparities. The primary aim of this study was to describe the treatment goals and preferences of Black veterans with chronic musculoskeletal pain who were enrolled in the intervention arm of a randomized controlled trial testing a coaching intervention. In the coaching sessions, participants (n = 106) identified their most important pain-related treatment goals and preferences. Participants' top treatment goals were to improve physical functioning (61%), increase engagement in valued activities (45%), and reduce pain intensity (37%). Most participants (73%) preferred non-pharmacological treatments (eg, physical therapy, exercise, acupuncture, yoga). The 17% of participants who identified medications as a preferred treatment demonstrated higher levels of depression and anxiety compared to those who did not. Approximately 42% and 21% of participants stated a preference to avoid pharmacological and surgical pain treatments, respectively. Black patients with chronic pain prioritize improving physical functioning and pain intensity in service of increasing their engagement in exercise, work, relationships, and leisure activities. Also, in the current study, patients expressed a clear preference for non-pharmacological pain treatments. Future research should investigate ways to improve communication of goals and preferences with providers and facilitate access to non-pharmacological treatments for Black patients with chronic pain. PERSPECTIVE: This article describes the treatment goals and preferences of Black veterans with chronic pain. Most patients prioritized goals to improve physical functioning, pain severity, and participation in valued activities. Patients primarily preferred non-pharmacological treatments. This emphasizes the need for clear communication with Black patients regarding pain-related goals and non-pharmacological treatment options.
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Affiliation(s)
- Mackenzie L Shanahan
- Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Kevin L Rand
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Amanda Galloway
- Department of Psychology, Indiana University, Indianapolis, Indiana
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana; Regenstrief Institute, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Washington L, Bronson J, Timko C, Han B, Blue-Howells J, Finlay AK. Health Conditions and Treatment Utilization Among Older Male Veterans Incarcerated in Prisons. J Gen Intern Med 2024; 39:1369-1377. [PMID: 38228986 PMCID: PMC11169130 DOI: 10.1007/s11606-023-08587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND More than 50,000 older male veterans incarcerated in prisons are expected to return to their communities and utilize the Veterans Health Administration (VHA) and community healthcare systems. To support the continuity of healthcare and overall successful community reentry of older incarcerated veterans, an understanding of their health profiles and treatment utilization while in correctional care is needed. OBJECTIVE To assess the health status of older male veterans incarcerated in state prisons and explore demographic, military, and VHA-related factors associated with medical conditions, disabilities, behavioral conditions, and medical and behavioral treatment utilization. DESIGN/PARTICIPANTS Cross-sectional observational study of 880 male veterans aged 50 + incarcerated in state prisons using data from the 2016 Bureau of Justice Statistics Survey of Prison Inmates. MAIN MEASURES Veteran status, self-report health status, and treatment utilization since prison admission. Prevalence rates for conditions and treatment utilization were calculated. Logistic regression models were used to examine the association of characteristics with conditions and treatment utilization. KEY RESULTS Among the 880 older male veterans in state prisons, the majority reported having a current medical condition (79.3%) or disability (61.6%), almost half had history of a mental health condition (44.5%), and more than a quarter (29%) had a substance use disorder. Compared to White veterans, Black veterans were less likely to report a disability or mental health condition. Few demographic, military, and VA-related characteristics were associated with medical or behavioral conditions or treatment utilization. CONCLUSION Our results suggest that the VHA and community healthcare systems need to be prepared to address medical and disability conditions among the majority of older male veterans who will be leaving prison and returning to their communities. Integrated medical and behavioral healthcare delivery models may be especially important for these veterans as many did not receive behavioral health treatment while in prison.
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Affiliation(s)
- Lance Washington
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA.
| | | | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Benjamin Han
- Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, San Diego, USA
- Veterans Affairs San Diego Healthcare System, San Diego, USA
| | - Jessica Blue-Howells
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
| | - Andrea K Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Rd (152-MPD), Menlo Park, CA, 94025, USA
- National Center On Homelessness Among Veterans, Veterans Health Administration, Menlo Park, CA, USA
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Krishnamurthy S, Li Y, Sileanu F, Essien UR, Vanneman ME, Mor M, Fine MJ, Thorpe CT, Radomski T, Suda K, Gellad WF, Roberts ET. Racial and Ethnic Differences in Health Care Experiences for Veterans Receiving VA Community Care from 2016 to 2021. J Gen Intern Med 2024:10.1007/s11606-024-08818-3. [PMID: 38822210 DOI: 10.1007/s11606-024-08818-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Prior research documented racial and ethnic disparities in health care experiences within the Veterans Health Administration (VA). Little is known about such differences in VA-funded community care programs, through which a growing number of Veterans receive health care. Community care is available to Veterans when care is not available through the VA, nearby, or in a timely manner. OBJECTIVE To examine differences in Veterans' experiences with VA-funded community care by race and ethnicity and assess changes in these experiences from 2016 to 2021. DESIGN Observational analyses of Veterans' ratings of community care experiences by self-reported race and ethnicity. We used linear and logistic regressions to estimate racial and ethnic differences in community care experiences, sequentially adjusting for demographic, health, insurance, and socioeconomic factors. PARTICIPANTS Respondents to the 2016-2021 VA Survey of Healthcare Experiences of Patients-Community Care Survey. MEASURES Care ratings in nine domains. KEY RESULTS The sample of 231,869 respondents included 24,306 Black Veterans (mean [SD] age 56.5 [12.9] years, 77.5% male) and 16,490 Hispanic Veterans (mean [SD] age 54.6 [15.9] years, 85.3% male). In adjusted analyses pooled across study years, Black and Hispanic Veterans reported significantly lower ratings than their White and non-Hispanic counterparts in five of nine domains (overall rating of community providers, scheduling a recent appointment, provider communication, non-appointment access, and billing), with adjusted differences ranging from - 0.04 to - 0.13 standard deviations (SDs) of domain scores. Black and Hispanic Veterans reported higher ratings with eligibility determination and scheduling initial appointments than their White and non-Hispanic counterparts, and Black Veterans reported higher ratings of care coordination, with adjusted differences of 0.05 to 0.21 SDs. Care ratings improved from 2016 to 2021, but differences between racial and ethnic groups persisted. CONCLUSIONS This study identified small but persistent racial and ethnic differences in Veterans' experiences with VA-funded community care, with Black and Hispanic Veterans reporting lower ratings in five domains and, respectively, higher ratings in three and two domains. Interventions to improve Black and Hispanic Veterans' patient experience could advance equity in VA community care.
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Affiliation(s)
- Sudarshan Krishnamurthy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yaming Li
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Florentina Sileanu
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Utibe R Essien
- VA Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, West Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Megan E Vanneman
- Decision Enhancement and Analytic Sciences Center, VA Informatics, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Maria Mor
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Michael J Fine
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Carolyn T Thorpe
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas Radomski
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Katie Suda
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric T Roberts
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Clair KS, Bean-Mayberry B, Schweizer CA, Chanfreau C, Jackson L, Than CT, Finley EP, Hamilton A, Farmer MM. Factors Associated with Delayed Care Among Women Veterans Actively Engaged in Primary Care. J Womens Health (Larchmt) 2024; 33:604-612. [PMID: 38386795 DOI: 10.1089/jwh.2023.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Background: Delaying needed medical care contributes to greater health risks and higher long-term medical costs. Women Veterans with complex medical and mental health needs face increased barriers to timely care access. Objectives: In a sample of women Veterans with recent engagement in Veterans Administration (VA) primary care, we aimed to compare characteristics of women Veterans who delayed care in the past 6 months with those who did not and examine factors associated with self-reported delayed care. Our study aims to inform interventions focused on eliminating health care access disparities among women Veterans. Materials and Methods: An innovation to improve women Veterans' engagement and retention in evidence-based health care for cardiovascular (CV) risk reduction (CV Toolkit) was implemented across five primary care sites within the VA. Women Veterans who were exposed to at least one CV Toolkit component participated in a mailed survey (n = 253). We used multivariate logistic regression to model factors associated with delaying care, including trust in VA providers, positive mental health screening (i.e., positive screen for either depression or anxiety), traumatic experience, self-rated health, and age. Results: Women with any mental health symptoms (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.23-4.74) and women who had experienced a traumatic event (OR 2.61, 95%CI: 1.11-6.14) were significantly more likely to report delaying care. Conclusions: Our study identified high rates of delayed care-over one-third of respondents-among women Veterans with recent primary care engagement. Mental health symptoms were the most common reported reason for delay among those who delayed care. Clinical Trial registration: NCT02991534.
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Affiliation(s)
- Kimberly S Clair
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Bevanne Bean-Mayberry
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - C Amanda Schweizer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Catherine Chanfreau
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - LaShawnta Jackson
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Claire T Than
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Erin P Finley
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Alison Hamilton
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Jane and Terry Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Melissa M Farmer
- VA Health Service Research and Development, Center for the Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Aurora P, Paquette CE, Beckham JC, Pugh MJ, Kimbrel NA, Calhoun PS. Mental health treatment utilization among Gulf War era veterans with probable alcohol use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 160:209295. [PMID: 38272121 PMCID: PMC11060892 DOI: 10.1016/j.josat.2024.209295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/17/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Alcohol use disorder (AUD) is prevalent among veterans, and excessive alcohol use is associated with significant mental and physical health consequences. Currently, the largest cohort of veterans seeking services at the VA are those from the 1990s Gulf War Era. This cohort of veterans is unique due to the nature of their deployment resulting in a myriad of unexplained symptoms collectively known as "Gulf War Illness" and higher rates of mental health problems. The present study sought to examine the association between probable AUD and mental health treatment utilization in a sample of 1126 (882 male) Gulf War-era veterans. METHODS Veterans completed a self-report survey including the AUDIT-C, questions about mental health treatment engagement, and demographic questions. RESULTS Results demonstrated that approximately 20 % of the sample screened positive for probable AUD, determined by standard AUDIT-C cutoff scores. Among those screening positive for AUD, 25 % reported engaging in mental health treatment in the past year. Veterans with probable AUD who use VA care had 3.8 times the odds of receiving mental health services than veterans not using VA care. Use of mental health services was associated with mental health comorbidity and identifying as Black/African American. CONCLUSIONS The results of the present study highlight a significant unmet need for mental health treatment among Gulf War-era veterans with AUD.
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Affiliation(s)
- Pallavi Aurora
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.
| | - Catherine E Paquette
- Durham VA Health Care System, Durham, NC, USA; Department of Psychology and Neuroscience, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Mary Jo Pugh
- School of Medicine, Department of Medicine, University of Utah, Salt Lake City, UT, USA; VA Salt Lake City Healthcare System, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham VA Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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Gaffey AE, Chang TE, Brandt CA, Haskell SG, Dhruva SS, Bastian LA, Levine A, Skanderson M, Burg MM. Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.22.24306203. [PMID: 38712220 PMCID: PMC11071551 DOI: 10.1101/2024.04.22.24306203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Background Proactive blood pressure (BP) management is particularly beneficial for younger Veterans, who have a greater prevalence and earlier onset of cardiovascular disease than non-Veterans. It is unknown what proportion of younger Veterans achieve and maintain BP control after hypertension onset and if BP control differs by demographics and social deprivation. Methods Electronic health records were merged from Veterans who enrolled in VA care 10/1/2001-9/30/2017 and met criteria for hypertension - first diagnosis or antihypertensive fill. BP control (140/90 mmHg), was estimated 1, 2, and 5 years post-hypertension documentation, and characterized by sex, race, and ethnicity. Adjusted logistic regressions assessed likelihood of BP control by these demographics and with the Social Deprivation Index (SDI). Results Overall, 17% patients met criteria for hypertension (n=198,367; 11% of women, median age 41). One year later, 59% of men and 65% of women achieved BP control. After adjustment, women had a 72% greater odds of BP control than men, with minimal change over 5 years. Black adults had a 22% lower odds of BP control than White adults. SDI did not significantly change these results. Conclusions In the largest study of hypertension in younger Veterans, 41% of men and 35% of women did not have BP control after 1 year, and BP control was consistently better for women through 5 years. Thus, the first year of hypertension management portends future, long-term BP control. As social deprivation did not affect BP control, the VA system may protect against disadvantages observed in the general U.S. population.
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Affiliation(s)
- Allison E. Gaffey
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (Cardiovascular Medicine)
| | - Tiffany E. Chang
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Cynthia A. Brandt
- VA Connecticut Healthcare System, West Haven, CT
- Department of Biostatistics, Yale School of Medicine
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (General Medicine), Yale School of Medicine
| | - Sanket S. Dhruva
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
- Section of Cardiology, Department of Medicine, UCSF School of Medicine
| | - Lori A. Bastian
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (General Medicine), Yale School of Medicine
| | | | | | - Matthew M. Burg
- VA Connecticut Healthcare System, West Haven, CT
- Department of Internal Medicine (Cardiovascular Medicine)
- Department of Anesthesiology, Yale School of Medicine
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Dismuke-Greer C, Esmaeili A, Ozieh MN, Gujral K, Garcia C, Del Negro A, Davis B, Egede L. Racial/Ethnic and Geographic Disparities in Comorbid Traumatic Brain Injury-Renal Failure in US Veterans and Associated Veterans Affairs Resource Costs, 2000-2020. J Racial Ethn Health Disparities 2024; 11:652-668. [PMID: 36864369 PMCID: PMC10474245 DOI: 10.1007/s40615-023-01550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/04/2023]
Abstract
Studies have identified disparities by race/ethnicity and geographic status among veterans with traumatic brain injury (TBI) and renal failure (RF). We examined the association of race/ethnicity and geographic status with RF onset in veterans with and without TBI, and the impact of disparities on Veterans Health Administration resource costs. METHODS Demographics by TBI and RF status were assessed. We estimated Cox proportional hazards models for progression to RF and generalized estimating equations for inpatient, outpatient, and pharmacy cost annually and time since TBI + RF diagnosis, stratified by age. RESULTS Among 596,189 veterans, veterans with TBI progressed faster to RF than those without TBI (HR 1.96). Non-Hispanic Black veterans (HR 1.41) and those in US territories (HR 1.71) progressed faster to RF relative to non-Hispanic Whites and those in urban mainland areas. Non-Hispanic Blacks (-$5,180), Hispanic/Latinos ($-4,984), and veterans in US territories (-$3,740) received fewer annual total VA resources. This was true for all Hispanic/Latinos, while only significant for non-Hispanic Black and US territory veterans < 65 years. For veterans with TBI + RF, higher total resource costs only occurred ≥ 10 years after TBI + RF diagnosis ($32,361), independent of age. Hispanic/Latino veterans ≥ 65 years received $8,248 less than non-Hispanic Whites and veterans living in US territories < 65 years received $37,514 less relative to urban veterans. CONCLUSION Concerted efforts to address RF progression in veterans with TBI, especially in non-Hispanic Blacks and those in US territories, are needed. Importantly, culturally appropriate interventions to improve access to care for these groups should be a priority of the Department of Veterans Affairs priority for these groups.
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Affiliation(s)
- Clara Dismuke-Greer
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA.
| | - Aryan Esmaeili
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | - Mukoso N Ozieh
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Kritee Gujral
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | - Carla Garcia
- Health Economics Resource Center (HERC), Ci2i, VA Palo Alto Healthcare System, 795 Willow Road, 152 MPD, Menlo Park, CA, 94025, USA
| | | | - Boyd Davis
- Department of English Emerita, College of Liberal Arts & Sciences, The University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Leonard Egede
- Center for Advancing Population Science (CAPS), Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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9
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Singal S, Howell D, Hanna L, Tang SX, Van Meter A, Saito E, Kane JM, Michaels TI. Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting. Psychiatr Serv 2024; 75:308-315. [PMID: 37855100 DOI: 10.1176/appi.ps.20230057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Patients' race and age have each been identified as risk factors for experiencing restraint events during psychiatric hospitalization. Restraint duration is also an important variable in determining disparities in treatment. To the authors' knowledge, no studies to date have examined the effect of the interaction of race and age on restraint use and duration in inpatient psychiatric settings. This retrospective chart review of electronic medical records of patients admitted between 2012 and 2019 sought to examine whether race and age interacted in predicting differences in the use and duration of restraints in a psychiatric inpatient setting. METHODS Logistic and hierarchical regression analyses were conducted on data from a sample of 29,739 adolescent (ages 12-17 years) and adult (ages ≥18 years) inpatients to determine whether the interaction of race and age group (adolescent or adult) significantly predicted a restraint event or differences in restraint duration. RESULTS Black (adjusted OR [AOR]=1.85) and multiracial (AOR=1.36) patients were more likely to experience a restraint event than were their White peers. Black race was also significantly (p=0.001) associated with longer restraint duration. No significant interaction was detected between race and age in predicting restraint events or duration. CONCLUSIONS Although the interaction between race and age did not predict restraint events or duration, the findings indicate racial disparities in the frequency and duration of restraint events among Black and multiracial individuals and may inform efforts to reduce these events.
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Affiliation(s)
- Sonali Singal
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Danielle Howell
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Lauren Hanna
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Sunny X Tang
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Anna Van Meter
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Ema Saito
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - John M Kane
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
| | - Timothy I Michaels
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, New York (Singal, Tang, Kane); Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers, State University of New Jersey, New Brunswick (Singal); Donald and Barbara Zucker School of Medicine, Hofstra/Northwell Health, Hempstead, New York (Howell, Hanna, Kane, Michaels); Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York (Hanna, Tang, Van Meter, Saito, Michaels); Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University, New York City (Van Meter)
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Sun J, Frick KD, Liang H, Chow CM, Aronowitz S, Shi L. Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States. PLoS One 2024; 19:e0290105. [PMID: 38416784 PMCID: PMC10901319 DOI: 10.1371/journal.pone.0290105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/01/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. METHODS A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. RESULTS Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. CONCLUSION Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.
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Affiliation(s)
- Jingjing Sun
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kevin D Frick
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailun Liang
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- School of Administration and Policy, Renmin University of China, Beijing, China
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sofia Aronowitz
- Independent Researcher, Albany, New York, United States of America
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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11
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Zelin NS, Scott C, Avila-Quintero VJ, Curlin K, Flores JM, Bloch MH. Sexual Orientation and Racial Bias in Relation to Medical Specialty. JOURNAL OF HOMOSEXUALITY 2024; 71:574-599. [PMID: 36269161 DOI: 10.1080/00918369.2022.2132441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Physician explicit and implicit biases involving race and sexual orientation (SO) affect patient and provider experiences in healthcare settings. An anonymous survey was disseminated nationally to graduating medical students, residents, and practicing physicians to evaluate SO and racial biases across medical specialties. SO explicit and implicit bias were measured with the Attitudes toward Lesbians and Gay Men Scale, short form (ATLG-S) and Gay-Straight Implicit Association Test (IAT). Racial explicit and implicit bias were measured with the Quick Discrimination Index (QDI) and the Black-White IAT. Medical specialty was associated with racial explicit bias and specialty prestige with Black-White IAT score. Medical specialty and specialty prestige were not associated with SO bias. Female sex, sexual and gender minority (SGM) identity, and decreased religiosity were associated with reduced SO and racial bias. Provider race was associated with racial implicit and explicit bias.
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Affiliation(s)
| | - Carter Scott
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kaveri Curlin
- Irvine School of Medicine, University of California, Irvine, California, USA
| | - Jose M Flores
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael H Bloch
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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12
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Krasner H, Harmon N, Martin J, Olaco CA, Netski DM, Batra K. Community Level Correlates of COVID-19 Booster Vaccine Hesitancy in the United States: A Cross-Sectional Analysis. Vaccines (Basel) 2024; 12:167. [PMID: 38400150 PMCID: PMC10892894 DOI: 10.3390/vaccines12020167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Introduction: Evidence exists that individual-level sociodemographic factors contribute to vaccine hesitancy, but it is unknown how community-level factors affect COVID-19 booster dose hesitancy. The current study aims to fill this knowledge gap by comparing data from a nationwide survey on COVID-19 vaccine hesitancy with a community-level indicator, i.e., the Distressed Communities Index (DCI). Methods: Attitudes toward vaccinations, vaccine literacy, COVID-19 vaccine confidence index, and trust were measured using a 48-item, psychometrically valid and reliable survey tool. In this study, 2138 survey participants residing in the United States were divided into quintiles of varying community distress levels based on their zip codes using the DCI. Data were analyzed through Chi-square, one-way ANOVA, and post hoc analysis with Tukey's test. Results: A significantly higher proportion of participants from the distressed communities had lower trust than their prosperous counterparts (26.6% vs. 37.6%, p < 0.001). On the contrary, participants from the prosperous communities had significantly higher vaccine confidence index scores than those in distressed communities (2.22 ± 1.13 vs. 1.70 ± 1.01, p < 0.001). Conclusions: These findings affirm the importance of developing community-level interventions to promote trust in COVID-19 vaccinations and increase booster dose uptake. From these results, future studies can examine the efficacy of various community-level interventions.
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Affiliation(s)
- Henry Krasner
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Nicolette Harmon
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA;
| | - Jeffrey Martin
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Crysty-Ann Olaco
- Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA; (J.M.); (C.-A.O.)
| | - Dale M. Netski
- Office of Faculty Affairs, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA;
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
| | - Kavita Batra
- Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
- Office of Research, Kirk Kerkorian School of Medicine at UNLV, University of Nevada, Las Vegas, NV 89102, USA
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13
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Matthias MS, Bolla AL, Bair SM, Adams J, Eliacin J, Burgess DJ, Hirsh AT. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): a Qualitative Analysis of a Tailored Coaching Program for Black Patients with Chronic Pain. J Gen Intern Med 2024; 39:222-228. [PMID: 37726645 PMCID: PMC10853119 DOI: 10.1007/s11606-023-08410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Racial inequities in pain treatment are well-documented and persist despite national priorities focused on health equity. The COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity) intervention was a patient-centered, tailored intervention aimed at improving health equity by targeting patient activation-the knowledge and confidence to manage one's health. COOPERATE led to significant and sustained increases in patient activation, significant short-term increases in communication self-efficacy (confidence to communicate with clinicians), and more intervention participants experienced clinically significant (≥ 30%) reductions in pain at 3 months than control group participants. OBJECTIVE To understand how participants experienced the intervention, including their perspectives on its effects on their health and healthcare experiences. DESIGN Semi-structured qualitative interviews. PARTICIPANTS Black veterans with chronic pain who participated in the COOPERATE intervention. KEY RESULTS Participants described acquiring new tools and cultivating skills to use in their clinic visits, including preparing for their visit (writing an agenda, listing questions); asking focused, effective questions; and expressing concerns and communicating goals, values, and preferences. Participants indicated that by putting these tools to use, they felt more confident and able to take ownership of their own pain care; for some, this led to better pain management and improved pain. Participants expressed mixed views of disparities in pain care, with some believing race and racism did not play a role in their care, while others valued being part of an intervention that helped equip them with tools to exercise autonomy over their healthcare. CONCLUSIONS Black patients with chronic pain described gaining greater confidence to self-manage and communicate with their clinicians after participating in the COOPERATE intervention. With its focus on empowering individuals, the COOPERATE intervention represents a promising approach to help advance equity in pain care.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA.
- Regenstrief Institute, Indianapolis, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA.
| | - Arya L Bolla
- Regenstrief Institute, Indianapolis, USA
- Indiana University School of Medicine, Indianapolis, USA
| | | | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, USA
- Regenstrief Institute, Indianapolis, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, USA
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, USA
- Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, USA
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14
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Matthias MS, Daggy JK, Perkins AJ, Adams J, Bair MJ, Burgess DJ, Eliacin J, Flores P, Myers LJ, Menen T, Procento P, Rand KL, Salyers MP, Shanahan ML, Hirsh AT. Communication and activation in pain to enhance relationships and treat pain with equity (COOPERATE): a randomized clinical trial. Pain 2024; 165:365-375. [PMID: 37733487 DOI: 10.1097/j.pain.0000000000003021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Racialized disparities in chronic pain care are well-documented and persist despite national priorities focused on health equity. Similar disparities have been observed in patient activation (ie, having the knowledge, confidence, and skills to manage one's health). As such, interventions targeting patient activation represent a novel approach to addressing and reducing disparities in pain care. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity is a randomized controlled trial of a 6-session telephone-delivered intervention to increase patient activation for Black patients with chronic pain. Two hundred fifty Black patients from a Midwestern Veterans Affairs medical center were randomized to the intervention or attention control. The primary outcome was patient activation; secondary outcomes included communication self-efficacy, pain, and psychological functioning. Outcomes were assessed at baseline and at 3 (primary endpoint), 6, and 9 months (sustained effects). Analyses used an intent-to-treat approach. Compared with baseline, patient activation increased 4.6 points at 3 months (versus +0.13 in control group, 95% CI: 0.48, 7.34; P = 0.03). These improvements in the intervention group were sustained, with +7 from baseline at 6 months and +5.77 at 9 months, and remained statistically significant from the control group. Communication self-efficacy increased significantly relative to the control group from baseline to 3 months. Pain intensity and interference improved at 3 months, but differences were not significant after adjusting for multiple comparisons. Most other secondary outcomes improved, but group differences were not statistically significant after controlling for multiple comparisons. Results suggest that increasing patient activation is a potentially fruitful path toward improving pain management and achieving health equity.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Joanne K Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Diana J Burgess
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
- Regenstrief Institute, Indianapolis, IN, United States
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
| | - Mackenzie L Shanahan
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States
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15
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Tsai S, Ma S, Nielsen TR, Calia C. Assessment of Dementia in Minority Ethnic Groups in Scotland: Results of a Survey of Cognitive Specialists. Alzheimer Dis Assoc Disord 2024; 38:85-90. [PMID: 38315885 DOI: 10.1097/wad.0000000000000608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Minority ethnic groups (MEGs) in Europe receive suboptimal dementia evaluation, yet related research in Scotland is lacking. This research examined the evaluation of dementia in MEGs in Scotland and compared it with previous research to highlight the changes in the clinical evaluation of dementia over the decade. DESIGN AND SETTING A self-administered survey was created online and emailed to 14 Heads of the boards under the Scottish National Health Service and dementia-associated settings and organizations. RESULTS Most surveyed centers (85.6%) received MEG referrals. Although 92.9% of the centers used professional translators when needed, 85.7% thought assessing dementia in MEGs was difficult, mostly due to the suitability of test instruments and rating scales and patients' linguistic abilities. Very few found their skills to be good in evaluating MEGs. There was no mention of specialized dementia services for MEGs. CONCLUSIONS The lack of culturally appropriate instruments and specialized dementia services reveals that the services are not ready to meet the demand for evaluating patients from diverse cultural and language backgrounds. Inadequate clinical evaluation may lead to misdiagnoses. Therefore, although significant work has been carried out in the past few years, improvements must be continued to enhance the current practices and apply suitable evaluation methods for MEGs.
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Affiliation(s)
- Somying Tsai
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Shuning Ma
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
| | - Thomas Rune Nielsen
- Department of Psychology, Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Clara Calia
- Department of Clinical Psychology, School of Health in Social Science, Medical School, The University of Edinburgh, Edinburgh, UK
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16
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Tighe CA, Berlin GS, Boland EM, Miller KE, Bramoweth AD. Identifying predictors of the amount of veteran participation in cognitive behavioral therapy for insomnia in the Veterans Affairs health care system. Psychol Serv 2023:2024-22275-001. [PMID: 37917476 PMCID: PMC11063118 DOI: 10.1037/ser0000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Insomnia is a prevalent and negatively impactful disorder among veterans. The Department of Veterans Affairs (VA) has committed significant resources to the development and dissemination of training related to cognitive behavioral therapy for insomnia (CBT-I), the recommended first-line intervention for chronic insomnia disorder. It has been established that VA clinicians can be effectively trained to deliver high fidelity CBT-I and that treatment results in significant improvements in insomnia. However, there is a paucity of research examining rates and predictors of veterans' participation in CBT-I in routine VA clinical care. In this study, we conducted a secondary analysis of data from VA electronic health records (EHR) to determine individual predisposing, enabling, and need factors associated with CBT-I participation. The sample included veterans who had at least one CBT-I templated note from the VA mid-Atlantic region of the United States (VISN4) between 2015 and 2019 in their chart (N = 2,801). CBT-I participation was defined by number of CBT-I templated notes occurring within a 6-month period from the initial note. Findings indicated that veterans most often completed only one session of CBT-I and, on average, completed approximately three sessions. Results from multinomial logistic regression identified significant associations of race, the presence of comorbid mental health disorders, rurality, presence of insomnia diagnosis, and insomnia medication with CBT-I participation; associations varied depending on how CBT-I participation was defined. More work is needed to better understand factors contributing to participation and reasons for completion and noncompletion of CBT-I. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Caitlan A Tighe
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | | | | | - Katherine E Miller
- Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center
| | - Adam D Bramoweth
- Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
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17
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Bartley T, O'Connor R, Beard K. Should All Nurses Be Required to Complete Implicit Bias Training? Am J Nurs 2023; 123:20-21. [PMID: 37882396 DOI: 10.1097/01.naj.0000995336.31551.4e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Bias mitigation requires a systematic approach.
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Affiliation(s)
- Tanya Bartley
- Tanya Bartley is director of clinical simulation at the Mercy University School of Nursing, Dobbs Ferry, NY. Rebecca O'Connor is an associate professor at the University of Washington School of Nursing in Seattle. Kenya Beard is dean and chief nursing officer at the Mercy University School of Nursing, and a member of AJN's editorial board. Contact author: Tanya Bartley, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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18
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Hargrave AS, Danan ER, Than CT, Gibson CJ, Yano EM. Factors Associated with Military Sexual Trauma (MST) Disclosure During VA Screening Among Women Veterans. J Gen Intern Med 2023; 38:3188-3197. [PMID: 37291361 PMCID: PMC10651589 DOI: 10.1007/s11606-023-08257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/24/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Capturing military sexual trauma (MST) exposure is critical for Veterans' health equity. For many, it improves access to VA services and allows for appropriate care. OBJECTIVE Identify factors associated with nondisclosure of MST in VA screening among women. DESIGN Cross-sectional telephone survey linked with VA electronic health record (EHR) data. PARTICIPANTS Women Veterans using primary care or women's health services at 12 VA facilities in nine states. MAIN MEASURES Survey self-reported MST (sexual assault and/or harassment during military service), socio-demographics and experiences with VA care, as well as EHR MST results. Responses were categorized as "no MST" (no survey or EHR MST), "MST captured by EHR and survey," and "MST not captured by EHR" (survey MST but no EHR MST). We used stepped multivariable logistic regression to examine "MST not captured by EHR" as a function of socio-demographics, patient experiences, and screening method (survey vs. EHR). KEY RESULTS Among 1287 women (mean age 50, SD 15), 35% were positive for MST by EHR and 61% were positive by survey. Approximately 38% had "no MST," 34% "MST captured by EHR and survey," and 26% "MST not captured by EHR". In fully adjusted models, odds of "MST not captured by EHR" were higher among Black and Latina women compared to white women (Black: OR = 1.6, 1.2-2.2; Latina: OR = 1.9, 1.0-3.6). Women who endorsed only sexual harassment in the survey (vs. sexual harassment and sexual assault) had fivefold higher odds of "MST not captured by EHR" (OR = 4.9, 3.2-7.3). Women who were screened for MST in the EHR more than once had lower odds of not being captured (OR = 0.3, 0.2-0.4). CONCLUSIONS VA screening for MST may disproportionately under capture patients from historically minoritized ethnic/racial groups, creating inequitable access to resources. Efforts to mitigate screening disparities could include re-screening and reinforcing that MST includes sexual harassment.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
- San Francisco VA Health Care System, San Francisco, CA, USA.
| | - Elisheva R Danan
- Division of General Internal Medicine, Minneapolis VA Medical Center: Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Claire T Than
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Sciences, San Francisco, CA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA
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Akin FW, Swan AA, Kalvesmaki A, Hall CD, Riska KM, Stressman KD, Nguyen H, Amuan M, Pugh MJ. Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans. Am J Audiol 2023; 32:706-720. [PMID: 37040302 DOI: 10.1044/2023_aja-22-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
PURPOSE The primary aim of this study was to examine the factors associated with long-term outcomes of postconcussive disruptive dizziness in Veterans of the post-9/11 wars. METHOD For this observational cohort study, the Neurobehavioral Symptom Inventory-Vestibular subscale (NSI-V) score was used as an outcome measure for dizziness in 987 post-9/11 Veterans who indicated disruptive dizziness at an initial Veterans Health Administration Comprehensive Traumatic Brain Injury Evaluation (CTBIE). An NSI-V change score was calculated as the difference in the scores obtained at the initial CTBIE and on a subsequent survey. Differences in the NSI-V change scores were examined for demographics, injury characteristics, comorbidities, and vestibular and balance function variables, and multiple linear regression analyses were used to explore associations among the variables and the NSI-V change score. RESULTS The majority of Veterans (61%) demonstrated a decrease in the NSI-V score, suggesting less dizziness on the survey compared with the CTBIE; 16% showed no change; and 22% had a higher score. Significant differences in the NSI-V change score were observed for traumatic brain injury (TBI) status, diagnoses of post-traumatic stress disorder (PTSD), headache and insomnia, and vestibular function. Multivariate regressions revealed significant associations between the NSI-V change score and the initial CTBIE NSI-V score, education level, race/ethnicity, TBI status, diagnoses of PTSD or hearing loss, and vestibular function. CONCLUSIONS Postconcussive dizziness can continue for years following an injury. Factors associated with poor prognosis include TBI, diagnoses of PTSD or hearing loss, abnormal vestibular function, increased age, identification as a Black Veteran, and high school education level.
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Affiliation(s)
- Faith W Akin
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Department of Audiology & Speech-Language Pathology, East Tennessee State University, Johnson City
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio
| | - Andrea Kalvesmaki
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Courtney D Hall
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Physical Therapy Program, East Tennessee State University, Johnson City
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Kara D Stressman
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Huong Nguyen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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20
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Peltzman T, Forehand JA, Freytes IM, Shiner B. Rural and Urban Hispanic Patients of the Veterans Health Administration. J Racial Ethn Health Disparities 2023; 10:2273-2283. [PMID: 36100811 DOI: 10.1007/s40615-022-01406-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/05/2023]
Abstract
Hispanic Veterans are the largest growing racial and ethnic minority group in the Veterans Health Administration (VA) system. Though recent research has found increasing suicide rates in this population and a growing rural-urban disparity, literature on core population characteristics remains sparse. We used extensive patient demographic and clinical data from VA's electronic medical record repository to examine geographic and longitudinal variation in Hispanic VA patients from 2001 to 2018. As the first such detailed characterization of this population, this study was largely descriptive in nature, and included heatmaps of Hispanic patient residence across rural and urban US counties, along with descriptive measures of patient characteristics by rurality, and first year of VA use. We found that Hispanic patients (n = 722,893) represented 5.2% of new VA users between 2001 and 2018, a proportion which grew nearly 90% from 4.0% (2001-2006) to 7.5% (2013-2018). Hispanic patients were largely White, male, under age 50, and had minimal illness or disability. The highest prevalence of Hispanic patients was in the Southwest US/Mexico border region, while the Midwest experienced the largest growth of Hispanic patients. Rural Hispanic patients were more likely to be older, male, and to live in areas characterized by small foreign-born populations and high socioeconomic deprivation. Compared with Hispanic patients entering the VA system in 2001-2006, patients in 2013-2018 were younger, more likely to be female, and to live in urban areas. These findings illustrate the wide range of demographic, clinical, and geographic experiences in the growing VA Hispanic population and demonstrate that culturally competent care for Hispanic Veterans must reflect their intra-ethnic diversity.
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Affiliation(s)
- Talya Peltzman
- Mental Health and Behavioral Science Service, Veterans Affairs Medical Center, White River Junction, VT, USA.
| | - Jenna A Forehand
- Mental Health and Behavioral Science Service, Veterans Affairs Medical Center, White River Junction, VT, USA
| | - Ivette M Freytes
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Brian Shiner
- Mental Health and Behavioral Science Service, Veterans Affairs Medical Center, White River Junction, VT, USA
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center, White River Junction, VT, USA
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21
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Sakamoto MS, Hanson KL, Chanfreau-Coffinier C, Lai MHC, Román CAF, Clark AL, Marquine MJ, Delano-Wood L, Merritt VC. An Examination of Racial/Ethnic Differences on the Neurobehavioral Symptom Inventory Among Veterans Completing the Comprehensive Traumatic Brain Injury Evaluation: A Veterans Affairs Million Veteran Program Study. Arch Clin Neuropsychol 2023; 38:929-943. [PMID: 36702773 PMCID: PMC10656879 DOI: 10.1093/arclin/acad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The purpose of this study was to explore racial/ethnic differences in neurobehavioral symptom reporting and symptom validity testing among military veterans with a history of traumatic brain injury (TBI). METHOD Participants of this observational cross-sectional study (N = 9,646) were post-deployed Iraq-/Afghanistan-era veterans enrolled in the VA's Million Veteran Program with a clinician-confirmed history of TBI on the Comprehensive TBI Evaluation (CTBIE). Racial/ethnic groups included White, Black, Hispanic, Asian, Multiracial, Another Race, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander. Dependent variables included neurobehavioral symptom domains and symptom validity assessed via the Neurobehavioral Symptom Inventory (NSI) and Validity-10, respectively. RESULTS Chi-square analyses showed significant racial/ethnic group differences for vestibular, somatic/sensory, and affective symptoms as well as for all Validity-10 cutoff scores examined (≥33, ≥27, ≥26, >22, ≥22, ≥13, and ≥7). Follow-up analyses compared all racial/ethnic groups to one another, adjusting for sociodemographic- and injury-related characteristics. These analyses revealed that the affective symptom domain and the Validity-10 cutoff of ≥13 revealed the greatest number of racial/ethnic differences. CONCLUSIONS Results showed significant racial/ethnic group differences on neurobehavioral symptom domains and symptom validity testing among veterans who completed the CTBIE. An enhanced understanding of how symptoms vary by race/ethnicity is vital so that clinical care can be appropriately tailored to the unique needs of all veterans. Results highlight the importance of establishing measurement invariance of the NSI across race/ethnicity and underscore the need for ongoing research to determine the most appropriate Validity-10 cutoff score(s) to use across racially/ethnically diverse veterans.
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Affiliation(s)
- McKenna S Sakamoto
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Karen L Hanson
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | | | - Mark H C Lai
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Alexandra L Clark
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - María J Marquine
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lisa Delano-Wood
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
| | - Victoria C Merritt
- Research & Psychology Services, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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22
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Swan AA, Kennedy E, Cooper DB, Amuan ME, Mayo J, Tate DF, Song K, Eapen BC, Van Cott AC, Lopez MR, Pugh MJ. Comorbidity and polypharmacy impact neurobehavioral symptoms and symptom validity failure among post-9/11 veterans with mild traumatic brain injury. Front Neurol 2023; 14:1228377. [PMID: 37538260 PMCID: PMC10395329 DOI: 10.3389/fneur.2023.1228377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
Objective The study aimed to examine the association between post-concussive comorbidity burdens [post-traumatic stress disorder (PTSD), depression, and/or headache] and central nervous system (CNS) polypharmacy (five or more concurrent medications) with reported neurobehavioral symptoms and symptom validity screening among post-9/11 veterans with a history of mild traumatic brain injury (mTBI). Setting Administrative medical record data from the Department of Veterans Affairs (VA) were used in the study. Participants Post-9/11 veterans with mTBI and at least 2 years of VA care between 2001 and 2019 who had completed the comprehensive traumatic brain injury evaluation (CTBIE) were included in the study. Design Retrospective cross-sectional design was used in the study. Main measures Neurobehavioral Symptom Inventory (NSI), International Classification of Diseases, Ninth Revision, and Clinical Modification diagnosis codes were included in the study. Results Of the 92,495 veterans with a history of TBI, 90% had diagnoses of at least one identified comorbidity (PTSD, depression, and/or headache) and 28% had evidence of CNS polypharmacy. Neurobehavioral symptom reporting and symptom validity failure was associated with comorbidity burden and polypharmacy after adjusting for sociodemographic characteristics. Veterans with concurrent diagnoses of PTSD, depression, and headache were more than six times more likely [Adjusted odds ratio = 6.55 (99% CI: 5.41, 7.92)]. to fail the embedded symptom validity measure (Validity-10) in the NSI. Conclusion TBI-related multimorbidity and CNS polypharmacy had the strongest association with neurobehavioral symptom distress, even after accounting for injury and sociodemographic characteristics. Given the regular use of the NSI in clinical and research settings, these findings emphasize the need for comprehensive neuropsychological evaluation for individuals who screen positively for potential symptom overreporting, the importance of multidisciplinary rehabilitation to restore functioning following mTBI, and the conscientious utilization of symptom validity measures in research efforts.
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Affiliation(s)
- Alicia A. Swan
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Eamonn Kennedy
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
- University of Utah School of Medicine Department of Neurology, Salt Lake City, UT, United States
| | - Douglas B. Cooper
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio, TX, United States
- Departments of Rehabilitation Medicine and Psychiatry, The University of Texas Health San Antonio, San Antonio, TX, United States
| | - Megan E. Amuan
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
| | - Jamie Mayo
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
| | - David F. Tate
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- University of Utah School of Medicine Department of Neurology, Salt Lake City, UT, United States
| | - Kangwon Song
- Augusta University Medical Center, Augusta University, Augusta, GA, United States
| | - Blessen C. Eapen
- Department of Physical Medicine and Rehabilitation, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Physical Medicine and Rehabilitation, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anne C. Van Cott
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Veterans Affairs, Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Maria R. Lopez
- Bruce Carter Hospital, Miami Veterans Health Administration, Miami, FL, United States
- Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Mary Jo Pugh
- Veterans Affairs Salt Lake City Health Care System, Informatics Decision Enhancement and Analytic Sciences Center of Innovation, Salt Lake City, UT, United States
- Division of Epidemiology, University of Utah School of Medicine Department of Internal Medicine, Salt Lake City, UT, United States
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23
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Navuluri N, Morrison S, Green CL, Woolson SL, Riley IL, Cox CE, Zullig LL, Shofer S. Racial Disparities in Lung Cancer Screening Among Veterans, 2013 to 2021. JAMA Netw Open 2023; 6:e2318795. [PMID: 37326987 PMCID: PMC10276308 DOI: 10.1001/jamanetworkopen.2023.18795] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Racial disparities in lung cancer screening (LCS) are often ascribed to barriers such as cost, insurance status, access to care, and transportation. Because these barriers are minimized within the Veterans Affairs system, there is a question of whether similar racial disparities exist within a Veterans Affairs health care system in North Carolina. Objectives To examine whether racial disparities in completing LCS after referral exist at the Durham Veterans Affairs Health Care System (DVAHCS) and, if so, what factors are associated with screening completion. Design, Setting, and Participants This cross-sectional study assessed veterans referred to LCS between July 1, 2013, and August 31, 2021, at the DVAHCS. All included veterans self-identified as White or Black and met the US Preventive Services Task Force eligibility criteria as of January 1, 2021. Participants who died within 15 months of consultation or who were screened before consultation were excluded. Exposures Self-reported race. Main Outcomes and Measures Screening completion was defined as completing computed tomography for LCS. The associations among screening completion, race, and demographic and socioeconomic risk factors were assessed using logistic regression models. Results A total of 4562 veterans (mean [SD] age, 65.4 [5.7] years; 4296 [94.2%] male; 1766 [38.7%] Black and 2796 [61.3%] White) were referred for LCS. Of all veterans referred, 1692 (37.1%) ultimately completed screening; 2707 (59.3%) never connected with the LCS program after referral and an informational mailer or telephone call, indicating a critical point in the LCS process. Screening rates were substantially lower among Black compared with White veterans (538 [30.5%] vs 1154 [41.3%]), with Black veterans having 0.66 times lower odds (95% CI, 0.54-0.80) of screening completion after adjusting for demographic and socioeconomic factors. Conclusions and Relevance This cross-sectional study found that after referral for initial LCS via a centralized program, Black veterans had 34% lower odds of LCS screening completion compared with White veterans, a disparity that persisted even after accounting for numerous demographic and socioeconomic factors. A critical point in the screening process was when veterans must connect with the screening program after referral. These findings may be used to design, implement, and evaluate interventions to improve LCS rates among Black veterans.
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Affiliation(s)
- Neelima Navuluri
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Samantha Morrison
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Isaretta L. Riley
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Christopher E. Cox
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Leah L. Zullig
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Scott Shofer
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
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24
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Hutchison PJ, Joshi N, Wasson K. When the Bridge Crumbles: Balancing ECMO-DT With Transplant Program Needs. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:49-51. [PMID: 37220357 DOI: 10.1080/15265161.2023.2201203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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25
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Hausmann LR, Lamorte C, Estock JL. Understanding the Context for Incorporating Equity into Quality Improvement Throughout a National Health Care System. Health Equity 2023; 7:312-320. [PMID: 37284535 PMCID: PMC10240324 DOI: 10.1089/heq.2023.0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 06/08/2023] Open
Abstract
Purpose Although health care systems aspire to deliver equitable care, practical tools that empower the health care workforce to weave equity throughout quality improvement (QI) processes are lacking. In this article, we report findings from context of use interviews that informed the development of a user-centered tool to support equity-focused QI. Methods Semistructured interviews were conducted from February to April of 2019. Participants included 14 medical center administrators, departmental or service line leaders, and clinical staff involved in direct patient care from three Veterans Affairs (VA) Medical Centers within a single region. Interviews covered existing practices for monitoring health care quality (i.e., priorities, tasks, workflow, and resources) and explored how equity data might fit into current processes. Themes extracted through rapid qualitative analysis were used to draft initial functional requirements for a tool to support equity-focused QI. Results Although the potential value of examining disparities in health care quality was clearly recognized, the data necessary for examining disparities were lacking for most quality measures. Interviewees also desired guidance on how inequities could be addressed through QI. The ways in which QI initiatives were selected, carried out, and supported also had important design implications for tools to support equity-focused QI. Discussion The themes identified in this work guided the development of a national VA Primary Care Equity Dashboard to support equity-focused QI within VA. Understanding the ways in which QI was carried out across multiple levels of the organization provided a successful foundation upon which to build functional tools to support thoughtful engagement around equity in clinical settings.
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Affiliation(s)
- Leslie R.M. Hausmann
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jamie L. Estock
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Higgins MCSS, Seren A, Foster MV, Sturgeon DJ, Bart N, Hederstedt K, Friefeld A, Lamkin RP, Sullivan BA, Branch-Elliman W, Mull HJ. Arteriovenous Graft Failure in the Veterans Health Administration: Outcome Disparities Associated with Race. Radiology 2023; 307:e220619. [PMID: 36809217 PMCID: PMC11262058 DOI: 10.1148/radiol.220619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Vascular access for ongoing hemodialysis often fails, frequently requiring repeated procedures to maintain vascular patency. While research has shown racial discrepancies in multiple aspects of renal failure treatment, there is poor understanding of how these factors might relate to vascular access maintenance procedures after arteriovenous graft (AVG) placement. Purpose To evaluate racial disparities associated with premature vascular access failure after percutaneous access maintenance procedures following AVG placement using a retrospective national cohort from the Veterans Health Administration (VHA). Materials and Methods All hemodialysis vascular maintenance procedures performed at VHA hospitals between October 2016 and March 2020 were identified. To ensure the sample represented patients who consistently used the VHA, patients without AVG placement within 5 years of their first maintenance procedure were excluded. Access failure was defined as a repeat access maintenance procedure or as hemodialysis catheter placement occurring 1-30 days after the index procedure. Multivariable logistic regression analyses were performed to calculate prevalence ratios (PRs) measuring the association between hemodialysis maintenance failure and African American race compared with all other races. Models controlled for vascular access history, patient socioeconomic status, and procedure and facility characteristics. Results In total, 1950 access maintenance procedures in 995 patients (mean age, 69 years ± 9 [SD], 1870 men) with an AVG created in one of 61 VHA facilities were identified. Most procedures involved African American patients (1169 of 1950, 60%) and patients residing in the South (1002 of 1950, 51%). Premature access failure occurred in 215 of 1950 (11%) procedures. When compared with all other races, African American race was associated with premature access site failure (PR, 1.4; 95% CI: 1.07, 1.43; P = .02). Among the 1057 procedures in 30 facilities with interventional radiology resident training programs, there was no evidence of racial disparity in the outcome (PR, 1.1; P = .63). Conclusion African American race was associated with higher risk-adjusted rates of premature arteriovenous graft failure after dialysis maintenance. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Forman and Davis in this issue.
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Affiliation(s)
- Mikhail C S S Higgins
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Alex Seren
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Marva V Foster
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Daniel J Sturgeon
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Nina Bart
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Kierstin Hederstedt
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Alex Friefeld
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Rebecca P Lamkin
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Brian A Sullivan
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Westyn Branch-Elliman
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
| | - Hillary J Mull
- From the Departments of Radiology (M.C.S.S.H.), Medical School (A.S., A.F.), Medicine (M.V.F.), and Surgery (H.J.M.), Boston University Chobanian & Avedisian School of Medicine, Boston, Mass; Department of Radiology, Boston Medical Center, Boston, Mass (M.C.S.S.H.); Center for Healthcare Organization and Implementation Research (M.F., D.J.S., K.H., R.P.L., W.B.E., H.J.M.), Department of Quality Management (M.V.F.), and Department of Medicine, Section of Infectious Diseases (W.B.E.), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130; Office of Clinical Affairs, Commonwealth Medicine, University of Massachusetts Chan Medical School, Boston, Mass (N.B.); Department of Gastroenterology, Duke University School of Medicine, Durham, NC (B.A.S.); Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC (B.A.S.); and Harvard Medical School, Boston, Mass (W.B.E.)
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27
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Burant CJ, Graham GC, Deimling G, Kresevic D, Kahana E, Wykle M, Kwoh CK, Ibrahim SA. The Effects of Osteoarthritis on Depressive Symptomatology Among Older U.S. Military Veterans. Int J Aging Hum Dev 2023; 96:267-284. [PMID: 35285279 DOI: 10.1177/00914150221084952] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) is a leading cause of disability among older adults. By 2050, approximately 60 million will suffer from arthritis adding up to a total societal cost of $65 billion. Chronic illnesses resulting in pain, and functional decline have been associated with depression in previous studies.A causal model was developed and tested using structural equation modeling that examined depression scores of 503 older (age 50-85), male Veterans with moderate to severe symptomatic OA of the knee\hip.The results of the structural equation modeling produced a final model of depressive symptomatology that fit the data well (Chi square = 12.23, DF = 11, p = .346; TLI = .99; CFI = 1.00; RMSEA = .02).The findings indicate the central role that OA severity (pain, stiffness, and functional difficulties) plays in the mental health of older Veterans in terms of the level of reported depressive symptoms.
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Affiliation(s)
- Christopher J Burant
- 2546Case Western Reserve University, Frances Payne Bolton School of Nursing; 20083Louis Stokes VA Medical Center, Geriatric Research Education and Clinical Center
| | - Gregory C Graham
- 15735Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - Gary Deimling
- 2546Case Western Reserve University, Department of Sociology
| | - Denise Kresevic
- 20083Louis Stokes VA Medical Center, Geriatric Research Education and Clinical Center; 24575University Hospitals of Cleveland
| | - Eva Kahana
- 2546Case Western Reserve University, Department of Sociology
| | - May Wykle
- 2546Case Western Reserve University, Frances Payne Bolton School of Nursing
| | - C Kent Kwoh
- University of Arizona Arthritis Center, University of Arizona, Tucson, AZ
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28
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Matthias MS, Burgess DJ, Eliacin J. Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study. J Gen Intern Med 2023; 38:1024-1029. [PMID: 36376625 PMCID: PMC9663172 DOI: 10.1007/s11606-022-07884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to significant disruptions in healthcare and rapid increases in virtual healthcare delivery. The full effects of these shifts remain unknown. Understanding effects of these disruptions is particularly relevant for patients with chronic pain, which typically requires consistent engagement in treatment to maximize benefit, and for Black patients, given documented racial disparities in pain treatment and telehealth delivery. OBJECTIVE To understand how Black patients with chronic pain experienced pandemic-related changes in healthcare delivery. DESIGN In-depth, semi-structured qualitative interviews PARTICIPANTS: Black veterans with chronic pain. KEY RESULTS Participants described decreased ability to self-manage their chronic pain, obtain nonpharmacological services such as physical therapy, see their primary care providers, and schedule surgery. Most did not believe telehealth met their needs, describing feeling inadequately assessed for their pain and noting that beyond renewing prescriptions, telehealth visits were not that useful. Some believed their communication with their providers suffered from a lack of in-person contact. Others, however, were willing to accept this tradeoff to prevent possible exposure to COVID-19, and some appreciated the convenience of being able to access healthcare from home. CONCLUSIONS Black patients with chronic pain described mostly negative effects from the shift to telecare after the pandemic's onset. Given existing disparities and likely persistence of virtual care, research on the longer-term effects of virtual pain care for Black patients is needed.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Regenstrief Institute, Indianapolis, IN, USA.
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Indianapolis, IN, USA
- Regenstrief Institute, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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29
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Browne J, Mohamed S. Evaluation of disparities in impact of mental health intensive case management on 6-month symptoms, functioning, and quality of life between black and white veterans diagnosed with schizophrenia. Schizophr Res 2023; 253:68-74. [PMID: 34247886 DOI: 10.1016/j.schres.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Substantial health disparities have been reported between Black and White Americans diagnosed with schizophrenia. The nature and extent of these disparities among individuals receiving services in an equal-access health care system remains understudied. PURPOSE AND AIMS The purpose of this study was to examine disparities in enrollment characteristics, service delivery and clinical outcomes between Black and White veterans diagnosed with schizophrenia who received care in the Veterans Health Administration (VHA), an equal-access health care system. METHODS National program evaluation data from the VHA Intensive Community Mental Health Recovery (ICMHR) program were used to evaluate disparities between 2436 Black and 3565 White veterans who enrolled between 1999 and 2013. Veterans and case managers completed measures of sociodemographic factors, clinical history, clinical characteristics, and justice system involvement at enrollment and six months. Chi square and ANOVAs were used to evaluate enrollment and service delivery differences. Six-month changes were evaluated using multiple regression controlling for potentially confounding baseline characteristics. Effect sizes were evaluated with Cohen's d. RESULTS Results indicated differences between Black and White veterans in clinical history, justice system involvement, and clinical characteristics at enrollment. Minimal differences in service delivery were noted and longitudinal analyses revealed no significant differences between Black and White veterans on the majority of outcomes. CONCLUSION Fewer racial disparities in service use and outcomes were observed in ICMHR than in standard non-VA clinic settings. This study demonstrates that disparities may emerge more strongly from systemic rather than individual-level differences.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Somaia Mohamed
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), West Haven CT, USA; Yale School of Medicine, New Haven, CT, USA.
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30
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Liou-Johnson V, Merced K, Klyce DW, Agtarap S, Finn JA, Chung JS, Campbell T, Harris OA, Perrin PB. Exploring racial/ethnic disparities in rehabilitation outcomes after TBI: A veterans affairs model systems study. NeuroRehabilitation 2023; 52:451-462. [PMID: 36806517 DOI: 10.3233/nre-220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Almost one-third of the U.S. military population is comprised of service members and veterans (SMVs) of color. Research suggests poorer functional and psychosocial outcomes among Black and Hispanic/Latine vs. White civilians following traumatic brain injury (TBI). OBJECTIVE This study examined racial/ethnic differences in 5-year functional independence and life satisfaction trajectories among SMVs who had undergone acute rehabilitation at one of five VA TBI Model Systems (TBIMS) Polytrauma Rehabilitation Centers (PRCs). METHODS Differences in demographic and injury-related factors were assessed during acute rehabilitation among White (n = 663), Black (n = 89) and Hispanic/Latine (n = 124) groups. Functional Independence Measure (FIM) Motor, FIM Cognitive, and Satisfaction with Life Scale (SWLS) scores were collected at 1, 2, and 5 years after injury. Racial/ethnic comparisons in these outcome trajectories were made using hierarchical linear modeling. RESULTS Black SMVs were less likely than White and Hispanic/Latine SMVs to have been deployed to a combat zone; there were no other racial/ethnic differences in any demographic or injury-related variable assessed. In terms of outcomes, no racial/ethnic differences emerged in FIM Motor, FIM cognitive, or SWLS trajectories. CONCLUSION The absence of observable racial/ethnic differences in 5-year outcome trajectories after TBI among SMVs from VA TBIMS PRCs contrasts sharply with previous research identifying disparities in these same outcomes and throughout the larger VA health care system. Individuals enrolled in VA PRCs are likely homogenized on key social determinants of health that would otherwise contribute to racial/ethnic disparities in outcome trajectories.
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Affiliation(s)
- Victoria Liou-Johnson
- Polytrauma Department, VA Palo Alto Healthcare Center, Palo Alto, CA, USA.,Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Kritzia Merced
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Daniel W Klyce
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Physical Medicine and Rehabilitation, Virginia Common wealth University, Richmond, VA, USA.,Sheltering Arms Institute, Richmond, VA, USA
| | | | - Jacob A Finn
- Rehabilitation and Extended Care, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Joyce S Chung
- Rehabilitation Department, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thomas Campbell
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA
| | - Odette A Harris
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Rehabilitation Department, Traumatic Brain Injury Center of Excellence, VA Palo Alto Health Care System, PaloAlto, CA, USA
| | - Paul B Perrin
- Central Virginia Veterans Affairs Health Care System, Richmond, VA, USA.,Department of Psychology, School of Data Science, University of Virginia, Charlottesville, VA, USA
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31
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Kaminstein DS, Brown KM. Conceptualizing the Carrying Function of Community Advisory Boards. JOURNAL OF APPLIED BEHAVIORAL SCIENCE 2023. [DOI: 10.1177/00218863231155490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Community Advisory Boards (CABs) often, “carry” important ideas and concepts for the larger organization of which they are a part. The word “carry” in this context, means that a person or group expresses verbal and nonverbal messages that inform others of what the institution acknowledges, and also what it cannot bear to feel or talk about. These expressions may include attitudes and expectations, values, risks, or disowned features and qualities. A group can contain, “carry,” and express formal, informal, and unconscious issues for a department or system. In this article, we situate our theoretical underpinning of this carrying function by relying on a number of literatures: identified patient, splitting and projection, parallel process, and container and contained. Specifying and examining the dynamics of what CABs carry for an institution can prevent common pitfalls for these groups, such as mistrust, feelings of disrespect, lack of productivity, and thwarted expectations.
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Affiliation(s)
- Dana S. Kaminstein
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly M. Brown
- VA Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, PA, USA
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Abstract
Mentorship and sponsorship are part of academia because they are vital for professional and personal development. Inclusive mentorship is defined as mentoring across differences. It highlights the need of all mentors to be well-versed culturally and to recognize and circumvent bias and microaggressions. Inclusive mentorship can also elevate underrepresented populations in medicine and create intercultural relationships that also benefit the relationships we have with our diversifying patient populations. There are still several barriers prohibiting inclusive mentorship from being widely understood and employed. This article discusses the importance of and techniques for improving inclusive mentorship.
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Affiliation(s)
| | - Erica Taylor
- Duke University School of Medicine, PO Box 1726, Wake Forest, NC 27587, USA.
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33
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Mares JG, Lund BC, Adamowicz JL, Burgess DJ, Rothmiller SJ, Hadlandsmyth K. Differences in chronic pain care receipt among veterans from differing racialized groups and the impact of rural versus urban residence. J Rural Health 2023. [PMID: 36695646 DOI: 10.1111/jrh.12744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE The current study aimed to identify differences in Veterans Affairs (VA) chronic pain care for Black, Asian, and Hispanic Americans, compared to non-Hispanic White Americans, and examine the intersection of race and rurality. METHODS Using national administrative data, all veterans who presented to the VA for chronic pain in 2018 were included. Demographic and comorbidity variables were built from 2018 data and health care utilization variables from 2019 data. Multivariate log-binomial regression models examined differences between racialized groups, and interactions with rural/urban residence, for each health care utilization variable. FINDINGS The full cohort included 2,135,216 veterans with chronic pain. There were no differences between racialized groups in pain-related primary care visits. Black Americans were less likely to receive pain clinic visits (aRR = 0.87, CI: 0.86-0.88). Rurality further decreased the likelihood of Black Americans visiting a pain clinic. Black, Hispanic, and Asian Americans were more likely to receive pain-related physical therapy visits relative to White Americans. Black and Hispanic Americans were more likely to present to emergency/urgent care for chronic pain. While there were no differences in pain-related primary care visits, the decreased likelihood of pain clinic visits and increased use of emergency department/urgent care among Black Americans could indicate inadequate management of chronic pain. CONCLUSIONS Tailored strategies are needed to provide equitable care that meets the needs of patients from racialized groups while accounting for systemic and cultural factors.
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Affiliation(s)
- Jasmine G Mares
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Brian C Lund
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Jenna L Adamowicz
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Psychological & Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Diana J Burgess
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
| | - Shamira J Rothmiller
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Counselor Education, University of Iowa, Iowa City, Iowa, USA
| | - Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Resource Center, Iowa City VA Health Care System, Iowa City, Iowa, USA.,Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.,Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
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34
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Azizoddin DR, Allsop M, Farah S, Salim F, Hauser J, Baltazar AR, Molokie R, Weber J, Weldon C, Feldman L, Martin JL. Oncology distress screening within predominately Black Veterans: Outcomes on supportive care utilization, hospitalizations, and mortality. Cancer Med 2022; 12:8629-8638. [PMID: 36573460 PMCID: PMC10134375 DOI: 10.1002/cam4.5560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND We evaluated whether patients' initial screening symptoms were related to subsequent utilization of supportive care services and hospitalizations, and whether patient-level demographics, symptoms, hospitalizations, and supportive care service utilization were associated with mortality in primarily low-income, older, Black Veterans with cancer. METHODS This quality improvement project created collaborative clinics to conduct cancer distress screenings and refer to supportive care services at an urban, VA medical center. All patients completed a distress screen with follow-up screening every 3 months. Supportive care utilization, hospitalization rates, and mortality were abstracted through medical records. Poisson regression models and cox proportional hazard models were utilized. RESULTS Five hundred and eighty five screened patients were older (m = 72), mostly Black 70% (n = 412), and had advanced cancer 54%. Fifty-eight percent (n = 340) were screened only once with 81% (n = 470) receiving ≥1 supportive care service and 51.5% (n = 297) being hospitalized ≥1 time 18 months following initial screen. Symptom severity was significantly related to number of hospitalizations. Low mood was significantly related to higher supportive services (p < 0.001), but not hospitalizations (p ≥ 0.52). Pain, fatigue, physical function, nutrition, and physical symptoms were significantly associated with more supportive services and hospitalizations (p < 0.01). Twenty percent (n = 168) died; Veterans who were Black, had lower stage cancers, better physical health, and utilized less supportive care services had lower odds of mortality (p ≤ 0.01). CONCLUSION Individuals with elevated distress needs and those reporting lower physical function utilized more supportive care services and had higher hospitalization rates. Lower physical function, greater supportive care use, higher stage cancer, and being non-Black were associated with higher odds of death.
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Affiliation(s)
- Desiree R. Azizoddin
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Matthew Allsop
- Academic Unit of Palliative Care Leeds Institute of Health Sciences, University of Leeds Leeds UK
| | - Subrina Farah
- Center for Clinical Investigation Brigham and Women's Hospital Boston Massachusetts USA
| | - Farah Salim
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | - Joshua Hauser
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Ashton R. Baltazar
- Health Promotion Research Center, Stephenson Cancer Center University of Oklahoma Health Sciences Center Oklahoma City Oklahoma USA
| | - Robert Molokie
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Jane Weber
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
| | | | - Lawrence Feldman
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Joanna L. Martin
- Department of Medicine Jesse Brown VA Medical Center Chicago Illinois USA
- Northwestern University Feinberg School of Medicine Chicago Illinois USA
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35
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Sheehan OC, Dhamoon MS, Bettger JP, Huang J, Liu C, Rhodes JD, Clay OJ, Roth DL. Racial differences in persistence to secondary prevention medication regimens after ischemic stroke. ETHNICITY & HEALTH 2022; 27:1671-1683. [PMID: 34196573 DOI: 10.1080/13557858.2021.1943321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Prior stroke is one of the biggest risk factors for future stroke events. Effective secondary prevention medication regimens can dramatically reduce recurrent stroke risk. Guidelines recommend the use of antithrombotic, antihypertensive and lipid-lowering medications after stroke. Medication adherence is known to be better in the presence of a caregiver but long-term adherence after stroke is unknown and disparities may persist. METHODS We examined the effects of race and sex on baseline prescription and maintenance of secondary prevention regimens in the presence of a caregiver using the Caring for Adults Recovering from the Effects of Stroke (CARES) study, an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS). RESULTS Incident ischemic stroke survivors (N = 172; 36% Black) with family caregivers had medications recorded at hospital discharge and on average 9.8 months later during a home visit. At discharge, antithrombotic prescription (95.9%), lipid-lowering medications (78.8%) and antihypertensives (89.9%) were common and there were no race or sex differences in discharge prescription rates. One year later, medication persistence had fallen to 86.6% for antithrombotics (p = 0.002) and 69.8% for lipid lowering (p = 0.008) but increased to 93.0% for antihypertensives (p = 0.30). Blacks were more likely to have discontinued antithrombotics than Whites (18.3% v 7.7%, p = 0.04). No significant differences in persistence were seen with age, sex, income, depression, or cognitive impairment. CONCLUSIONS Medication persistence was high in this sample, likely due to the presence of a caregiver. In our cohort, despite similar prescription rates at the time of hospital discharge, Black stroke survivors were more than twice as likely to stop antithrombotics than Whites. The effect of changes in patterns of medication usage on health outcomes in Black stroke survivors warrants continued investigation.
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Affiliation(s)
- Orla C Sheehan
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - Chelsea Liu
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
| | - J David Rhodes
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD, USA
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36
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Bakhshaie J, Penn TM, Doorley J, Pham TV, Greenberg J, Bannon S, Saadi A, Vranceanu AM. Psychosocial Predictors of Chronic Musculoskeletal Pain Outcomes and their Contextual Determinants Among Black Individuals: A Narrative Review. THE JOURNAL OF PAIN 2022; 23:1697-1711. [PMID: 35644442 DOI: 10.1016/j.jpain.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Black communities are disproportionally affected by Chronic Musculoskeletal Pain (CMP), but little is known about the psychological predictors of CMP outcomes and their contextual determinants among Black individuals. To address this gap, we conducted a narrative review of extant literature to (1) report the major conceptual models mentioned in prior work explaining the link between contextual determinants and psychological responses to pain among Black individuals with CMP; and (2) describe psychological factors related to CMP outcomes in this population that are highlighted in the literature. We searched 4 databases (APA PsycNet, PubMed/MEDLINE, Scopus, and Google Scholar) using the following search terms: musculoskeletal pain, chronic pain, mental health, psychological, coping, health disparities, contextual factors, conceptual models, psychosocial, Black, African American, pain, disability, and outcomes. We illustrate 3 relevant conceptual models - socioecological, cumulative stress, and biopsychosocial - related to contextual determinants and several psychological factors that influence CMP outcomes among Black individuals: (1) disproportionate burden of mental health and psychiatric diagnoses, (2) distinct coping strategies, (3) pain-related perceived injustice and perceived racial/ethnic discrimination, and (4) preferences and expectations related to seeking and receiving pain care. The detailed clinical and research implications could serve as a blueprint for the providers and clinical researchers to address health disparities and improve care for Black individuals with CMP. PERSPECTIVE: This narrative review illustrates conceptual models explaining the link between contextual determinants and psychological responses to pain among Black individuals with chronic musculoskeletal pain. We discuss 3 relevant conceptual models - socioecological, cumulative stress, biopsychosocial -, and 4 psychological factors: disproportionate burden of mental health, distinct coping strategies, perceived injustice/discrimination, preferences/expectations.
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Affiliation(s)
- Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Terence M Penn
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Tony V Pham
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Tulane Medical School, New Orleans, Louisiana; Duke University Global Health Master's Program, Durham, North Carolina
| | - Jonathan Greenberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sarah Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Altaf Saadi
- Harvard Medical School, Boston, Massachusetts; Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Peltzman T, Rice K, Jones KT, Washington DL, Shiner B. Optimizing Data on Race and Ethnicity for Veterans Affairs Patients. Mil Med 2022; 187:e955-e962. [PMID: 35323934 DOI: 10.1093/milmed/usac066] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Maintaining accurate race and ethnicity data among patients of the Veterans Affairs (VA) healthcare system has historically been a challenge. This work expands on previous efforts to optimize race and ethnicity values by combining multiple VA data sources and exploring race- and ethnicity-specific collation algorithms. MATERIALS AND METHODS We linked VA patient data from 2000 to 2018 with race and ethnicity data from four administrative and electronic health record sources: VA Medical SAS files (MedSAS), Corporate Data Warehouse (CDW), VA Centers for Medicare extracts (CMS), and VA Defense Identity Repository Data (VADIR). To assess the accuracy of each data source, we compared race and ethnicity values to self-reported data from the Survey of Health Experiences of Patients (SHEP). We used Cohen's Kappa to assess overall (holistic) source agreement and positive predictive values (PPV) to determine the accuracy of sources for each race and ethnicity separately. RESULTS Holistic agreement with SHEP data was excellent (K > 0.80 for all sources), while race- and ethnicity-specific agreement varied. All sources were best at identifying White and Black users (average PPV = 0.94, 0.93, respectively). When applied to the full VA user population, both holistic and race-specific algorithms substantially reduced unknown values, as compared to single-source methods. CONCLUSIONS Combining multiple sources to generate race and ethnicity values improves data accuracy among VA patients. Based on the overall agreement with self-reported data, we recommend using non-missing values from sources in the following order to fill in race values-SHEP, CMS, CDW, MedSAS, and VADIR-and in the following order to fill in ethnicity values-SHEP, CDW, MedSAS, VADIR, and CMS.
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Affiliation(s)
- Talya Peltzman
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | - Korie Rice
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
| | | | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles Geffen School of Medicine, Los Angeles, CA 90024, USA
| | - Brian Shiner
- White River Junction VA Medical Center, White River Junction, VT 05009, USA
- Geisel School of Medicine at Dartmouth College, Hanover, NH 03755, USA
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Matthias MS, Adams J, Burgess DJ, Daggy J, Eliacin J, Flores P, Hirsh AT, Myers LJ, Perkins AJ, Menen T, Procento P, Rand KL, Salyers MP, Shanahan ML, Bair MJ. Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity (COOPERATE): Rationale, study design, methods, and sample characteristics. Contemp Clin Trials 2022; 118:106790. [PMID: 35568376 DOI: 10.1016/j.cct.2022.106790] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic pain is associated with profound negative effects, and racial disparities are well-documented in chronic pain treatment. In addition, Black patients report poorer communication with providers and exhibit lower levels of patient activation (self-management self-efficacy) than White patients. Although the causes of healthcare disparities are complex and require intervention at multiple levels, empowering patients is one critical path to achieving health equity. The current study is a coaching intervention focused on increasing patient activation and building communication skills for Black patients with chronic pain. METHODS In this randomized controlled trial, 250 Black patients with chronic pain were randomized to either the coaching intervention or an attention control arm. Intervention patients attended 6 telephone-delivered individual coaching sessions over 12 weeks. Coaching focused on clarifying and prioritizing goals and on communication skills, such as agenda setting. The primary outcome is patient activation. Secondary outcomes include communication self-efficacy, pain intensity and interference, and psychological functioning. DISCUSSION Having the knowledge and confidence to participate in one's pain care, coupled with the skills needed to effectively communicate with providers, is essential to optimize chronic pain care. This is particularly important for Black patients who often experience lower quality pain care. Interventions such as COOPERATE hold promise for helping patients to acquire the requisite tools to take greater control of their chronic pain care. TRIAL REGISTRATION clinicaltrials.gov, # NCT03562793.
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Affiliation(s)
- Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America.
| | - Jasma Adams
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Diana J Burgess
- Center for Care Delivery and Outcomes Research, Veterans Affairs Medical Center, Minneapolis, MN, United States of America; Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Joanne Daggy
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Perla Flores
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Laura J Myers
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Anthony J Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Tetla Menen
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Philip Procento
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Kevin L Rand
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Michelle P Salyers
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Mackenzie L Shanahan
- Department of Psychology, Indiana University-Purdue University, Indianapolis, IN, United States of America
| | - Matthew J Bair
- VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, IN, United States of America; Regenstrief Institute, Indianapolis, IN, United States of America; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Swan AA, Akin FW, Amuan ME, Riska KM, Hall CD, Kalvesmaki A, Padilla S, Crowsey E, Pugh MJ. Disruptive Dizziness Among Post-9/11 Veterans With Deployment-Related Traumatic Brain Injury. J Head Trauma Rehabil 2022; 37:199-212. [PMID: 34320551 DOI: 10.1097/htr.0000000000000714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify disruption due to dizziness symptoms following deployment-related traumatic brain injury (TBI) and factors associated with receiving diagnoses for these symptoms. SETTING Administrative medical record data from the Department of Veterans Affairs (VA). PARTICIPANTS Post-9/11 veterans with at least 3 years of VA care who reported at least occasional disruption due to dizziness symptoms on the comprehensive TBI evaluation. DESIGN A cross-sectional, retrospective, observational study. MAIN MEASURES International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes of dizziness, vestibular dysfunction, and other postconcussive conditions; neurobehavioral Symptom Inventory. RESULTS Increased access to or utilization of specialty care at the VA was significant predictors of dizziness and/or vestibular dysfunction diagnoses in the fully adjusted model. Veterans who identified as Black non-Hispanic and those with substance use disorder diagnoses or care were substantially less likely to receive dizziness and vestibular dysfunction diagnoses. CONCLUSIONS Access to specialty care was the single best predictor of dizziness and vestibular dysfunction diagnoses, underscoring the importance of facilitating referrals to and utilization of specialized, comprehensive clinical facilities or experts for veterans who report disruptive dizziness following deployment-related TBI. There is a clear need for an evidence-based pathway to address disruptive symptoms of dizziness, given the substantial variation in audiovestibular tests utilized by US providers by region and clinical specialty. Further, the dearth of diagnoses among Black veterans and those in more rural areas underscores the potential for enhanced cultural competency among providers, telemedicine, and patient education to bridge existing gaps in the care of dizziness.
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Affiliation(s)
- Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio, San Antonio (Dr Swan and Ms Crowsey); South Texas Veterans Health Care System, San Antonio (Dr Swan); James H Quillen VA Medical Center, Mountain Home, Tennessee (Drs Akin and Hall); Departments of Audiology and Speech Language Pathology (Dr Akin) and Rehabilitative Sciences (Dr Hall), East Tennessee State University, Johnson City; Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, Utah (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Internal Medicine, University of Utah, Salt Lake City (Mss Amuan and Padilla and Drs Kalvesmaki and Pugh); Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, North Carolina (Dr Riska); and Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina (Dr Riska)
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Rentas C, Baker S, Goss L, Richman J, Knight SJ, Key C, Morris M. Patients undergoing colorectal surgery at a Veterans Affairs Hospital do not experience racial disparity in length of stay either before or after implementing an enhanced recovery pathway. BMC Surg 2022; 22:201. [PMID: 35598012 PMCID: PMC9124421 DOI: 10.1186/s12893-022-01647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Enhanced Recovery Pathways (ERP) have been shown to reduce racial disparities following surgery. The objective of this study is to determine whether ERP implementation mitigates racial disparities at a Veterans Affairs Hospital. Methods A retrospective cohort study was conducted using data obtained from the Veterans Affairs Surgical Quality Improvement Program. All patients undergoing elective colorectal surgery following ERP implementation were included. Current procedural terminology (CPT) codes were used to identify patients who underwent similar procedures prior to ERP implementation. Results Our study included 417 patients (314 pre-ERP vs. 103 ERP), 97.1% of which were male, with an average age of 62.32 (interquartile range (IQR): 25–90). ERP patients overall had a significantly shorter post-operative length of stay (pLOS) vs. pre-ERP patients (median 4 days (IQR: 3–6.5) vs. 6 days (IQR: 4–9) days (p < 0.001)). Within the pre-ERP group, median pLOS for both races was 6 days (IQR: 4–6; p < 0.976) and both groups experienced a decrease in median pLOS (4 vs. 6 days; p < 0.009 and p < 0.001) following ERP implementation. Conclusions Racial disparities did not exist in patients undergoing elective surgery at a single VA Medical Center. Implementation of an ERP significantly reduced pLOS for black and white patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01647-3.
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Affiliation(s)
- C Rentas
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.
| | - S Baker
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.,Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - L Goss
- Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - J Richman
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.,Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - S J Knight
- VA Salt Lake City Health Care System, University of Utah, 500 Foothill Dr, Salt Lake City, UT, 84148, USA
| | - C Key
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.,Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
| | - M Morris
- Department of Surgery, University of Alabama at Birmingham School of Medicine, 1808 7th Avenue South #503, Birmingham, AL, 35233, USA.,Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL, 35233, USA
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Wong YK, Low KL, Pooke TG. Factors Associated With Dimensions of Patients’ Trust in Chiropractic Doctors in the International Medical University Healthcare Chiropractic Center: An Exploratory Study. J Chiropr Med 2022; 21:83-96. [DOI: 10.1016/j.jcm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022] Open
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Karia PS, Huang Y, Tehranifar P, Visvanathan K, Wright JD, Genkinger JM. Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States. Am J Obstet Gynecol 2022; 227:257.e1-257.e22. [PMID: 35489439 PMCID: PMC9308662 DOI: 10.1016/j.ajog.2022.04.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/03/2022] [Accepted: 04/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Clinicians in the United States have rapidly adopted opportunistic salpingectomy for ovarian cancer prevention. However, little is known about racial and ethnic differences in opportunistic salpingectomy adoption. Surgical innovations in gynecology may be adopted differentially across racial and ethnic groups, exacerbating current disparities in quality of care. OBJECTIVE This study aimed to evaluate racial and ethnic differences in opportunistic salpingectomy adoption across inpatient and outpatient settings and assess the effect of national guidelines supporting opportunistic salpingectomy use on these differences. STUDY DESIGN A sample of 650,905 women aged 18 to 50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011 to 2018 was identified using the Premier Healthcare Database, an all-payer hospital administrative database, including more than 700 hospitals across the United States. The association between race and ethnicity and opportunistic salpingectomy use was examined using multivariable-adjusted mixed-effects log-binomial regression models accounting for hospital-level clustering. Models included race and ethnicity by year of surgery (2011-2013 [before guideline] and 2014-2018 [after guideline]) interaction term to test whether racial and ethnic differences in opportunistic salpingectomy adoption changed with the release of national guidelines supporting opportunistic salpingectomy use. RESULTS From 2011 to 2018, 82,792 women underwent hysterectomy and opportunistic salpingectomy (non-Hispanic White, 60.3%; non-Hispanic Black, 18.8%; Hispanic, 12.2%; non-Hispanic other race, 8.7%) and 23,398 women underwent opportunistic salpingectomy for sterilization (non-Hispanic White, 64.7%; non-Hispanic Black, 10.8%; Hispanic, 16.7%; non-Hispanic other race, 7.8%). The proportion of hysterectomy procedures involving an opportunistic salpingectomy increased from 6.3% in 2011 to 59.7% in 2018 (9.5-fold increase), and the proportion of sterilization procedures involving an opportunistic salpingectomy increased from 0.7% in 2011 to 19.4% in 2018 (27.7-fold increase). In multivariable-adjusted models, non-Hispanic Black (risk ratio, 0.94; 95% confidence interval, 0.92-0.97), Hispanic (risk ratio, 0.98; 95% confidence interval, 0.95-1.00), and non-Hispanic other race women (risk ratio, 0.93; 95% confidence interval, 0.90-0.96) were less likely to undergo hysterectomy and opportunistic salpingectomy than non-Hispanic White women. A significant interaction between race and ethnicity and year of surgery was noted in non-Hispanic Black compared with non-Hispanic White women (P<.001), with a reduction in differences in hysterectomy and opportunistic salpingectomy use after national guideline release (risk ratio2011-2013, 0.80 [95% confidence interval, 0.73-0.88]; risk ratio2014-2018, 0.98 [95% confidence interval, 0.95-1.01]). Moreover, non-Hispanic Black women were less likely to undergo an opportunistic salpingectomy for sterilization than non-Hispanic White women (risk ratio, 0.91; 95% confidence interval, 0.88-0.95), with no difference by year of surgery (P=.62). Stratified analyses by hysterectomy route and age at surgery revealed similar results. CONCLUSION Although opportunistic salpingectomy for ovarian cancer prevention has been rapidly adopted in the United States, our findings suggested that its adoption has not been equitable across racial and ethnic groups. Non-Hispanic Black, Hispanic, and non-Hispanic other race women were less likely to undergo opportunistic salpingectomy than non-Hispanic White women even after adjusting for sociodemographic, clinical, procedural, hospital, and provider characteristics. These differences persisted after the release of national guidelines supporting opportunistic salpingectomy use. Future research should focus on understanding the reasons for these differences to inform interventions that promote equity in opportunistic salpingectomy use.
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Affiliation(s)
- Pritesh S Karia
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Yongmei Huang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY.
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Scheuner MT, Huynh AK, Chanfreau-Coffinier C, Lerner B, Gable AR, Lee M, Simon A, Coeshott R, Hamilton AB, Patterson OV, DuVall S, Russell MM. Demographic Differences Among US Department of Veterans Affairs Patients Referred for Genetic Consultation to a Centralized VA Telehealth Program, VA Medical Centers, or the Community. JAMA Netw Open 2022; 5:e226687. [PMID: 35404460 PMCID: PMC9002339 DOI: 10.1001/jamanetworkopen.2022.6687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Telehealth enables access to genetics clinicians, but impact on care coordination is unknown. OBJECTIVE To assess care coordination and equity of genetic care delivered by centralized telehealth and traditional genetic care models. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included patients referred for genetic consultation from 2010 to 2017 with 2 years of follow-up in the US Department of Veterans Affairs (VA) health care system. Patients were excluded if they were referred for research, cytogenetic, or infectious disease testing, or if their care model could not be determined. EXPOSURES Genetic care models, which included VA-telehealth (ie, a centralized team of genetic counselors serving VA facilities nationwide), VA-traditional (ie, a regional service by clinical geneticists and genetic counselors), and non-VA care (ie, community care purchased by the VA). MAIN OUTCOMES AND MEASURES Multivariate regression models were used to assess associations between patient and consultation characteristics and the type of genetic care model referral; consultation completion; and having 0, 1, or 2 or more cancer surveillance (eg, colonoscopy) and risk-reducing procedures (eg, bilateral mastectomy) within 2 years following referral. RESULTS In this study, 24 778 patients with genetics referrals were identified, including 12 671 women (51.1%), 13 193 patients aged 50 years or older (53.2%), 15 639 White patients (63.1%), and 15 438 patients with cancer-related referrals (62.3%). The VA-telehealth model received 14 580 of the 24 778 consultations (58.8%). Asian patients, American Indian or Alaskan Native patients, and Hawaiian or Pacific Islander patients were less likely to be referred to VA-telehealth than White patients (OR, 0.54; 95% CI, 0.35-0.84) compared with the VA-traditional model. Completing consultations was less likely with non-VA care than the VA-traditional model (OR, 0.45; 95% CI, 0.35-0.57); there were no differences in completing consultations between the VA models. Black patients were less likely to complete consultations than White patients (OR, 0.84; 95% CI, 0.76-0.93), but only if referred to the VA-telehealth model. Patients were more likely to have multiple cancer preventive procedures if they completed their consultations (OR, 1.55; 95% CI, 1.40-1.72) but only if their consultations were completed with the VA-traditional model. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the VA-telehealth model was associated with improved access to genetics clinicians but also with exacerbated health care disparities and hindered care coordination. Addressing structural barriers and the needs and preferences of vulnerable subpopulations may complement the centralized telehealth approach, improve care coordination, and help mitigate health care disparities.
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Affiliation(s)
- Maren T. Scheuner
- San Francisco Veterans Affairs Health Care System, San Francisco, California
- University of California, San Francisco, School of Medicine, San Francisco
| | - Alexis K. Huynh
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | | | - Barbara Lerner
- Veterans Affairs Boston Health Care System, Boston, Massachusetts
| | - Alicia R. Gable
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Martin Lee
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
- University of California Los Angeles Fielding School of Public Health, Los Angeles
| | - Alissa Simon
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
| | - Randall Coeshott
- San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles
| | - Olga V. Patterson
- Veterans Affairs Informatics and Computing Infrastructure, Salt Lake City, Utah
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Scott DuVall
- Veterans Affairs Informatics and Computing Infrastructure, Salt Lake City, Utah
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Marcia M. Russell
- Center for the Study of Healthcare Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles
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Seal KH, Bertenthal D, Carey E, Grunfeld C, Bikle DD, Lu CM. Association of Vitamin D Status and COVID-19-Related Hospitalization and Mortality. J Gen Intern Med 2022; 37:853-861. [PMID: 34981368 PMCID: PMC8723909 DOI: 10.1007/s11606-021-07170-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND The relationship between vitamin D status and COVID-19-related clinical outcomes is controversial. Prior studies have been conducted in smaller, single-site, or homogeneous populations limiting adjustments for social determinants of health (race/ethnicity and poverty) common to both vitamin D deficiency and COVID-19 outcomes. OBJECTIVE To evaluate the dose-response relationship between continuous 25(OH)D and risk for COVID-19-related hospitalization and mortality after adjusting for covariates associated with both vitamin D deficiency and COVID-19 outcomes. DESIGN Retrospective cohort study. PATIENTS Veteran patients receiving care in US Department of Veteran Affairs (VA) health care facilities with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test and a blood 25(OH)D test between February 20, 2020, and November 8, 2020, followed for up to 60 days. MAIN MEASURES Exposure was blood 25(OH)D concentration ascertained closest to and within 15 to 90 days preceding an index positive SARS-CoV-2 test. Co-primary study outcomes were COVID-19-related inpatient hospitalization requiring airborne, droplet, contact, or other isolation and mortality ascertained within 60 days of an index positive SARS-CoV-2 test. KEY RESULTS Of 4,599 veterans with a positive SARS-CoV-2 test, vitamin D deficiency (< 20 ng/mL) was identified in 665 (14.5%); 964 (21.0%) were hospitalized; and 340 (7.4%) died. After adjusting for all covariates, including race/ethnicity and poverty, there was a significant independent inverse dose-response relationship between increasing continuous 25(OH)D concentrations (from 15 to 60 ng/mL) and decreasing probability of COVID-19-related hospitalization (from 24.1 to 18.7%, p=0.009) and mortality (from 10.4 to 5.7%, p=0.001). In modeling 25(OH)D as a log-transformed continuous variable, the greatest risk for hospitalization and death was observed at lower 25(OH)D concentrations. CONCLUSIONS Continuous blood 25(OH)D concentrations are independently associated with COVID-19-related hospitalization and mortality in an inverse dose-response relationship in this large racially and ethnically diverse cohort of VA patients. Randomized controlled trials are needed to evaluate the impact of vitamin D supplementation on COVID-19-related outcomes.
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Affiliation(s)
- Karen H Seal
- San Francisco Veterans Affairs Health Care System, Integrative Health Service, San Francisco, CA, USA. .,Departments of Medicine and Psychiatry, University of California San Francisco, San Francisco, CA, USA.
| | - Daniel Bertenthal
- San Francisco Veterans Affairs Health Care System, Integrative Health Service, San Francisco, CA, USA
| | - Evan Carey
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carl Grunfeld
- San Francisco Veterans Affairs Health Care System, Research Service and Division of Endocrinology and Metabolism, San Francisco, CA, USA.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Daniel D Bikle
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Health Care System, Division of Endocrinology and Metabolism and Dermatology, San Francisco, CA, USA
| | - Chuanyi M Lu
- Department of Laboratory Medicine, University of California San Francisco and San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
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Racial Disparities in 30-Day Outcomes After Colorectal Surgery in an Integrated Healthcare System. J Gastrointest Surg 2022; 26:433-443. [PMID: 34581979 DOI: 10.1007/s11605-021-05151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Racial disparities in colorectal surgery outcomes have been studied extensively in the USA, and access to healthcare resources may contribute to these differences. The Veterans Health Administration (VHA) is the largest integrated healthcare network in the USA with the potential for equal access care to veterans. The objective of this study is to evaluate the VHA for the presence of racial disparities in 30-day outcomes of patients that underwent colorectal resection. METHODS Colon and rectal resections from 2008 to 2019 were reviewed retrospectively using the Veterans Affairs Surgical Quality Improvement Program database. Patients were categorized by race and ethnicity. Multivariable analysis was used to compare 30-day outcomes. Cases with "unknown/other/declined to answer" race/ethnicity were excluded. RESULTS Thirty-six-thousand-nine-hundred-sixty-nine cases met inclusion criteria: 27,907 (75.5%) Caucasian, 6718 (18.2%) African American, 2047 (5.5%) Hispanic, and 290 (0.8%) Native American patients. There were no statistically significant differences in overall complication incidence or mortality between all cohorts. Compared to Caucasian race, African American patients had longer mean length of stay (10.7 days vs. 9.7 days; p < 0.001). Compared to Caucasian race, Hispanic patients had higher odds of pulmonary-specific complications (adjusted odds ratio with 95% confidence interval = 1.39 [1.17-1.64]; p < 0.001). CONCLUSIONS The VHA provides the benefits of integrated healthcare and access, which may explain the improvements in racial disparities compared to existing literature. However, some racial disparities in clinical outcomes still persisted in this analysis. Further efforts beyond healthcare access are needed to mitigate disparities in colorectal surgery. CLASSIFICATIONS: [Outcomes]; [Database]; [Veterans]; [Colorectal Surgery]; [Morbidity]; [Mortality].
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Gross GM, Smith N, Holliday R, Rozek DC, Hoff R, Harpaz-Rotem I. Racial Disparities in Clinical Outcomes of Veterans Affairs Residential PTSD Treatment Between Black and White Veterans. Psychiatr Serv 2022; 73:126-132. [PMID: 34369806 DOI: 10.1176/appi.ps.202000783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Racial disparities across various domains of health care are a long-standing public health issue that affect a variety of clinical services and health outcomes. Mental health research has shown that prevalence rates of posttraumatic stress disorder (PTSD) are high for Black veterans compared with White veterans, and some studies suggest poorer clinical outcomes for Black veterans with PTSD. The aim of this study was to examine the impact of racial disparities longitudinally in the U.S. Department of Veterans Affairs (VA) residential rehabilitation treatment programs (RRTPs). METHODS Participants included 2,870 veterans treated nationally in VA PTSD RRTPs in fiscal year 2017. Veterans provided demographic data upon admission to the program. Symptoms of PTSD and depression were collected at admission, discharge, and 4-month follow-up. Hierarchical linear modeling was used to examine symptom change throughout and after treatment. RESULTS Black veterans experienced attenuated PTSD symptom reduction during treatment as well as greater depression symptom recurrence 4 months after discharge, relative to White veterans. CONCLUSIONS This study adds to the body of literature that has documented poorer treatment outcomes for Black compared with White veterans with PTSD. Although both Black and White veterans had an overall reduction in symptoms, future research should focus on understanding the causes, mechanisms, and potential solutions to reduce racial disparities in mental health treatment.
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Affiliation(s)
- Georgina M Gross
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Noelle Smith
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ryan Holliday
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - David C Rozek
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Rani Hoff
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
| | - Ilan Harpaz-Rotem
- U.S. Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Yale University School of Medicine, New Haven, Connecticut (Gross, Smith, Hoff, Harpaz-Rotem); Rocky Mountain Mental Illness Research, Education and Clinical Center for Veteran Suicide Prevention, Aurora, Colorado (Holliday); University of Colorado Anschutz Medical Campus, Aurora (Holliday); UCF RESTORES, University of Central Florida, Orlando (Rozek)
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Williams BE, Kondo KK, Ayers CK, Kansagara D, Young S, Saha S. Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions. Health Equity 2022; 5:856-871. [PMID: 35018320 PMCID: PMC8742307 DOI: 10.1089/heq.2021.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.
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Affiliation(s)
- Beth E Williams
- Primary Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Karli K Kondo
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Research Integrity Office, Oregon Health and Science University, Portland, Oregon, USA
| | - Chelsea K Ayers
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Devan Kansagara
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA.,Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Sarah Young
- Evidence Synthesis Program, VA Portland Health Care System, Portland, Oregon, USA
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA.,Division of General Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Lin JS, Hoffman L, Bean SI, O'Connor EA, Martin AM, Iacocca MO, Bacon OP, Davies MC. Addressing Racism in Preventive Services: Methods Report to Support the US Preventive Services Task Force. JAMA 2021; 326:2412-2420. [PMID: 34747987 DOI: 10.1001/jama.2021.17579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
IMPORTANCE In January 2021, the US Preventive Services Task Force (USPSTF) issued a values statement that acknowledged systemic racism and included a commitment to address racism and health equity in recommendations for clinical preventive services. OBJECTIVES To articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. METHODS An audit was conducted assessing (1) published literature on frameworks or policy and position statements addressing racism, (2) a subset of cancer and cardiovascular topics in USPSTF reports, (3) recent systematic reviews on interventions to reduce health inequities in preventive health or to prevent racism in health care, and (4) health care-relevant professional societies, guideline-making organizations, agencies, and funding bodies to gather information about how they are addressing racism and health equity. FINDINGS Race as a social category does not have biological underpinnings but has biological consequences through racism. Racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. In its reports, the USPSTF has addressed racial and ethnic disparities, but not racism explicitly. The systematic reviews to support the USPSTF include interventions that may mitigate health disparities through cultural tailoring of behavioral interventions, but reviews have not explicitly addressed other commonly studied interventions to increase the uptake of preventive services or foster the implementation of preventive services. Many organizations have issued recent statements and commitments around racism in health care, but few have provided substantive guidance on operational steps to address the effects of racism. Where guidance is unavailable regarding the proposed actions, it is principally because work to achieve them is in very early stages. The most directly relevant and immediately useful guidance identified is that from the GRADE working group. CONCLUSIONS AND RELEVANCE This methods report provides a summary of issues around racism and health inequity, including the status of how these are being addressed in preventive health.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth A O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Allea M Martin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | | | - Melinda C Davies
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Cuevas AG, Cofie LE, Nolte S. The Association Between Veteran Status and Obesity Differs Across Race/Ethnicity. Am J Health Promot 2021; 36:314-317. [PMID: 34860589 DOI: 10.1177/08901171211052994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to evaluate the interaction between veteran status and race/ethnicity on obesity status. DESIGN Cross-sectional survey. SETTING The 2013-2017 National Health Interview Survey. SAMPLE A total of 151,765 adults (8.62% veterans and 91.38 nonveterans) with 69.30% identifying as White, 13.05% identifying as Hispanic, 12.57% identifying as Black, and 5.08% identifying as Asian. MEASURES Obesity status (measured using self-reported body mass index), race/ethnicity, survey year, age, marital status, educational attainment, federal poverty level, health insurance, type of insurance, self-reported health status, and whether participant had a usual care source. ANALYSIS Weighted logistic regression analysis. RESULTS In a fully adjusted model, there was no evidence that veterans overall had higher odds of obesity compared to nonveterans (adjusted odd ratio (aOR): 1.05, 95% CI: .99, 1.11). White veterans had lower odds of obesity compared to White nonveterans (OR: .93, 95% CI: .87, .98). Hispanic veterans had higher odds of obesity compared to Hispanic nonveterans (aOR: 1.53, 95% CI: 1.23, 1.90). There was no evidence of an association between veteran status and obesity status for Black and Asian adults. CONCLUSIONS Effectual prevention strategies are needed to decrease obesity risks among active and retired Hispanic veterans.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Leslie E Cofie
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Sarah Nolte
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
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50
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Silva GC, Jiang L, Gutman R, Wu WC, Mor V, Fine MJ, Kressin NR, Trivedi AN. Racial/Ethnic Differences in 30-Day Mortality for Heart Failure and Pneumonia in the Veterans Health Administration Using Claims-based, Clinical, and Social Risk-adjustment Variables. Med Care 2021; 59:1082-1089. [PMID: 34779794 PMCID: PMC8652730 DOI: 10.1097/mlr.0000000000001650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Prior studies have identified lower mortality in Black Veterans compared with White Veterans after hospitalization for common medical conditions, but these studies adjusted for comorbid conditions identified in administrative claims. OBJECTIVES The objectives of this study were to compare mortality for non-Hispanic White (hereafter, "White"), non-Hispanic Black (hereafter, "Black"), and Hispanic Veterans hospitalized for heart failure (HF) and pneumonia and determine whether observed mortality differences varied according to whether claims-based comorbid conditions and/or clinical variables were included in risk-adjustment models. RESEARCH DESIGN This was an observational study. SUBJECTS The study cohort included 143,520 admissions for HF and 127,782 admissions for pneumonia for Veterans hospitalized in 132 Veterans Health Administration (VA) Medical Centers between January 2009 and September 2015. MEASURES The primary independent variable was racial/ethnic group (ie, Black, Hispanic, and non-Hispanic White), and the outcome was all-cause mortality 30 days following admission. To compare mortality by race/ethnicity, we used logistic regression models that included different combinations of claims-based, clinical, and sociodemographic variables. For each model, we estimated the average marginal effect (AME) for Black and Hispanic Veterans relative to White Veterans. RESULTS Among the 143,520 (127,782) hospitalizations for HF (pneumonia), the average patient age was 71.6 (70.9) years and 98.4% (97.1%) were male. The unadjusted 30-day mortality rates for HF (pneumonia) were 7.2% (11.0%) for White, 4.1% (10.4%) for Black and 8.4% (16.9%) for Hispanic Veterans. Relative to White Veterans, when only claims-based variables were used for risk adjustment, the AME (95% confidence interval) for the HF [pneumonia] cohort was -2.17 (-2.45, -1.89) [0.08 (-0.41, 0.58)] for Black Veterans and 1.32 (0.49, 2.15) [4.51 (3.65, 5.38)] for Hispanic Veterans. When clinical variables were incorporated in addition to claims-based ones, the AME, relative to White Veterans, for the HF [pneumonia] cohort was -1.57 (-1.88, -1.27) [-0.83 (-1.31, -0.36)] for Black Veterans and 1.50 (0.71, 2.30) [3.30 (2.49, 4.11)] for Hispanic Veterans. CONCLUSIONS Compared with White Veterans, Black Veterans had lower mortality, and Hispanic Veterans had higher mortality for HF and pneumonia. The inclusion of clinical variables into risk-adjustment models impacted the magnitude of racial/ethnic differences in mortality following hospitalization. Future studies examining racial/ethnic disparities should consider including clinical variables for risk adjustment.
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Affiliation(s)
| | - Lan Jiang
- Providence VA Medical Center, Brown University School of Public Health, Providence, RI
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health
| | - Wen-Chih Wu
- Providence VA Medical Center, Brown University School of Public Health, Providence, RI
| | - Vincent Mor
- Providence VA Medical Center, Brown University School of Public Health, Providence, RI
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | - Michael J. Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Nancy R. Kressin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System
- School of Medicine, Boston University, Boston, MA
| | - Amal N. Trivedi
- Providence VA Medical Center, Brown University School of Public Health, Providence, RI
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
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