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Shannon EM, Jones KT, Moy E, Steers WN, Toyama J, Washington DL. Evaluation of regional variation in racial and ethnic differences in patient experience among Veterans Health Administration primary care users. Health Serv Res 2024. [PMID: 38808495 DOI: 10.1111/1475-6773.14328] [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: 05/30/2024] Open
Abstract
OBJECTIVE To evaluate racial and ethnic differences in patient experience among VA primary care users at the Veterans Integrated Service Network (VISN) level. DATA SOURCE AND STUDY SETTING We performed a secondary analysis of the VA Survey of Healthcare Experiences of Patients-Patient Centered Medical Home for fiscal years 2016-2019. STUDY DESIGN We compared 28 patient experience measures (six each in the domains of access and care coordination, 16 in the domain of person-centered care) between minoritized racial and ethnic groups (American Indian or Alaska Native [AIAN], Asian, Black, Hispanic, Multi-Race, Native Hawaiian or Other Pacific Islander [NHOPI]) and White Veterans. We used weighted logistic regression to test differences between minoritized and White Veterans, controlling for age and gender. DATA COLLECTION/EXTRACTION METHODS We defined meaningful difference as both statistically significant at two-tailed p < 0.05 with a relative difference ≥10% or ≤-10%. Within VISNs, we included tests of group differences with adequate power to detect meaningful relative differences from a minimum of five comparisons (domain agnostic) per VISN, and separately for a minimum of two for access and care coordination and four for person-centered care domains. We report differences as disparities/large disparities (relative difference ≥10%/≥ 25%), advantages (experience worse or better, respectively, than White patients), or equivalence. PRINCIPAL FINDINGS Our analytic sample included 1,038,212 Veterans (0.6% AIAN, 1.4% Asian, 16.9% Black, 7.4% Hispanic, 0.8% Multi-Race, 0.8% NHOPI, 67.7% White). Across VISNs, the greatest proportion of comparisons indicated disparities for three of seven eligible VISNs for AIAN, 6/10 for Asian, 3/4 for Multi-Race, and 2/6 for NHOPI Veterans. The plurality of comparisons indicated advantages or equivalence for 17/18 eligible VISNs for Black and 12/14 for Hispanic Veterans. AIAN, Asian, Multi-Race, and NHOPI groups had more comparisons indicating disparities by VISN in the access domain than person-centered care and care coordination. CONCLUSIONS We found meaningful differences in patient experience measures across VISNs for minoritized compared to White groups, especially for groups with lower population representation.
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Affiliation(s)
- Evan Michael Shannon
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - Kenneth T Jones
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - Ernest Moy
- Office of Health Equity, Veterans Health Administration, Washington, DC, USA
| | - W Neil Steers
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Joy Toyama
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Donna L Washington
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, California, USA
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Dionne E, Spadaro JZ, Atayde AMP, Kombo N. Antibiotic Prescribing Patterns Among U.S. Ophthalmologists and Optometrists from 2018 to 2021 in the Medicare Part D Database. J Ocul Pharmacol Ther 2024; 40:144-151. [PMID: 38206649 DOI: 10.1089/jop.2023.0126] [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: 01/12/2024] Open
Abstract
Purpose: To assess antibiotic prescribing patterns among ophthalmologists and optometrists from 2018 to 2021. Methods: This is an observational, retrospective cohort study of the Medicare Part D prescriber public use files from 2018 to 2020. Prescription trends were analyzed with analysis of variance and negative binomial regression tests based on specialty, region, and types of antibiotics. Results: From 2018 to 2021, the number of ophthalmologists in the Medicare Part D database decreased from 18,452 to 18,285, and the number of optometrists increased from 23,071 to 24,734. Throughout the study period, the total number and proportion of antibiotic prescriptions by ophthalmologists and optometrists stayed almost constant with a dip in 2020, likely reflecting the effects of the COVID-19 pandemic. Both ophthalmologists and optometrists demonstrated geographic regional differences in prescribing patterns. The South consistently had the highest average number of claims per provider. Of the antibiotics prescribed by ophthalmologists in 2021, 48.6% are from the fluoroquinolone class, 20.5% are from the aminoglycoside class, and 18.2% are from the macrolide class. Optometrists were found to be more likely to prescribe antibiotics in a formulation combined with a corticosteroid throughout the study period. Conclusions: Our results have shown that prescribing patterns among ophthalmologists and optometrists have demonstrated significant changes in prescriptions of microbial resistance-promoting antibiotics. These patterns persist despite nation-wide attempts to control antimicrobial resistance.
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Affiliation(s)
- Elyssa Dionne
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jane Z Spadaro
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Agata M P Atayde
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Beckett MK, Elliott MN, Hambarsoomian K, Tamayo L, Lehrman WG, Agniel D, Khau M, Goldstein E, Giordano LA, Ng JH, Martino SC. Do Hospital Characteristics Predict Racial-and-Ethnic Disparities in Patient Experience? National Results From the HCAHPS Survey. Med Care 2024; 62:37-43. [PMID: 37962434 DOI: 10.1097/mlr.0000000000001949] [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: 11/15/2023]
Abstract
OBJECTIVE Assess whether hospital characteristics associated with better patient experiences overall are also associated with smaller racial-and-ethnic disparities in inpatient experience. BACKGROUND Hospitals that are smaller, non-profit, and serve high proportions of White patients tend to be high-performing overall, but it is not known whether these hospitals also have smaller racial-and-ethnic disparities in care. RESEARCH DESIGN We used linear mixed-effect regression models to predict a summary measure that averaged eight Hospital CAHPS (HCAHPS) measures (Nurse Communication, Doctor Communication, Staff Responsiveness, Communication about Medicines, Discharge Information, Care Coordination, Hospital Cleanliness, and Quietness) from patient race-and-ethnicity, hospital characteristics (size, ownership, racial-and-ethnic patient-mix), and interactions of race-and-ethnicity with hospital characteristics. SUBJECTS Inpatients discharged from 4,365 hospitals in 2021 who completed an HCAHPS survey ( N =2,288,862). RESULTS While hospitals serving larger proportions of Black and Hispanic patients scored lower on all measures, racial-and-ethnic disparities were generally smaller for Black and Hispanic patients who received care from hospitals serving higher proportions of patients in their racial-and-ethnic group. Experiences overall were better in smaller and non-profit hospitals, but racial-and-ethnic differences were slightly larger. CONCLUSIONS Large, for-profit hospitals and hospitals serving higher proportions of Black and Hispanic patients tend to be lower performing overall but have smaller disparities in patient experience. High-performing hospitals might look at low-performing hospitals for how to provide less disparate care whereas low-performing hospitals may look to high-performing hospitals for how to improve patient experience overall.
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Affiliation(s)
| | | | | | - Loida Tamayo
- Centers for Medicare & Medicaid Services, Baltimore, MD
| | | | | | - Meagan Khau
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Lopez JL, Duarte G, Taylor CN, Ibrahim NE. Achieving Health Equity in the Care of Patients with Heart Failure. Curr Cardiol Rep 2023; 25:1769-1781. [PMID: 37975970 DOI: 10.1007/s11886-023-01994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW To discuss the prevailing racial and ethnic disparities in heart failure (HF) care by identifying barriers to equitable care and proposing solutions for achieving equitable outcomes. RECENT FINDINGS Throughout the entire spectrum of HF care, from prevention to implementation of guideline-directed medical therapy and advanced interventions, racial and ethnic disparities exist. Factors such as differential distribution of risk factors, poor access to care, inadequate representation in clinical trials, and discrimination from healthcare clinicians, among others, contribute to these disparities. Recent data suggests that despite improvements, disparities prevail in several aspects of HF care, hindering our progress towards equity in HF care. This review highlights the urgent need to address racial and ethnic disparities in HF care, emphasizing the importance of a multifaceted approach involving policy changes, quality improvement strategies, targeted interventions, and intentional community engagement. Our proposed framework was derived from existing research and emphasizes integrating equity into routine quality improvement efforts, tailoring interventions to specific populations, and advocating for policy transformation. By acknowledging these disparities, implementing evidence-based strategies, and fostering collaborative efforts, the HF community can strive to reduce disparities and achieve equity in HF care.
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Affiliation(s)
- Jose L Lopez
- Division of Cardiovascular Disease, JFK Hospital, University of Miami Miller School of Medicine, Atlantis, FL, USA
| | - Gustavo Duarte
- Division of Cardiology, Cleveland Clinic Florida, Weston, FL, USA
| | - Christy N Taylor
- Division of Cardiology, NewYork-Presbyterian Hospital, Columbia University Medical Center, New York City, NY, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA.
- The Equity in Heart Transplant Project, Inc, Boston, MA, USA.
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Kim CY, Gouin KA, Hicks LA, Kabbani S. Characteristics of patients associated with any outpatient antibiotic prescribing among Medicare Part D enrollees, 2007-2018. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e113. [PMID: 37502252 PMCID: PMC10369433 DOI: 10.1017/ash.2023.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 07/29/2023]
Abstract
The 2007-2018 National Health Interview Survey data linked with Medicare claims were used to examine older adults' characteristics and assess their associations with receiving an antibiotic prescription. This analysis shows variation in antibiotic prescribing among adults enrolled in Medicare Part D by race and ethnicity, sex, geography, and health status.
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Affiliation(s)
- Christine Y. Kim
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katryna A. Gouin
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauri A. Hicks
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah Kabbani
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lauffenburger JC, Khatib R, Siddiqi A, Albert MA, Keller PA, Samal L, Glowacki N, Everett ME, Hanken K, Lee SG, Bhatkhande G, Haff N, Sears ES, Choudhry NK. Reducing ethnic and racial disparities by improving undertreatment, control, and engagement in blood pressure management with health information technology (REDUCE-BP) hybrid effectiveness-implementation pragmatic trial: Rationale and design. Am Heart J 2023; 255:12-21. [PMID: 36220355 PMCID: PMC9742137 DOI: 10.1016/j.ahj.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND While racial/ethnic disparities in blood pressure control are documented, few interventions have successfully reduced these gaps. Under-prescribing, lack of treatment intensification, and suboptimal follow-up care are thought to be central contributors. Electronic health record (EHR) tools may help address these barriers and may be enhanced with behavioral science techniques. OBJECTIVE To evaluate the impact of a multicomponent behaviorally-informed EHR-based intervention on blood pressure control. TRIAL DESIGN Reducing Ethnic and racial Disparities by improving Undertreatment, Control, and Engagement in Blood Pressure management with health information technology (REDUCE-BP) (NCT05030467) is a two-arm cluster-randomized hybrid type 1 pragmatic trial in a large multi-ethnic health care system. Twenty-four clinics (>350 primary care providers [PCPs] and >10,000 eligible patients) are assigned to either multi-component EHR-based intervention or usual care. Intervention clinic PCPs will receive several EHR tools designed to reduce disparities delivered at different points, including a: (1) dashboard of all patients visible upon logging on to the EHR displaying blood pressure control by race/ethnicity compared to their PCP peers and (2) set of tools in an individual patient's chart containing decision support to encourage treatment intensification, ordering home blood pressure measurement, interventions to address health-related social needs, default text for note documentation, and enhanced patient education materials. The primary outcome is patient-level change in systolic blood pressure over 12 months between arms; secondary outcomes include changes in disparities and other clinical outcomes. CONCLUSION REDUCE-BP will provide important insights into whether an EHR-based intervention designed using behavioral science can improve hypertension control and reduce disparities.
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Affiliation(s)
- Julie C Lauffenburger
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Rasha Khatib
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
| | - Alvia Siddiqi
- Enterprise Population Health, Advocate Aurora Health, Downers Grove, IL
| | - Michelle A Albert
- Center for the Study of Adversity and Cardiovascular Disease (NURTURE Center), Division of Cardiology of Medicine (Cardiology), University of California, San Francisco, San Francisco, CA
| | | | - Lipika Samal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicole Glowacki
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL
| | | | - Kaitlin Hanken
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Simin G Lee
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Gauri Bhatkhande
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nancy Haff
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ellen S Sears
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences (C4HDS), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Weech-Maldonado R, Haviland AM, Hambarsoomian K, Martino SC, Dembosky JW, Tamayo L, Gaillot S, Elliott MN. Patient Experience for Hispanic Older Adults Varies by Language Preference. Med Care 2022; 60:895-900. [PMID: 36356290 DOI: 10.1097/mlr.0000000000001783] [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: 11/12/2022]
Abstract
BACKGROUND Hispanic people with Medicare report worse patient experiences than non-Hispanic White counterparts. However, little research examines how these disparities may vary by language preference (English/Spanish). OBJECTIVES Using Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data, assess whether 2014-2018 disparities in patient experiences for Hispanic people with Medicare vary by language preference. RESEARCH DESIGN We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures by race/ethnicity/language preference (Hispanic Spanish-respondents; Hispanic Spanish-preferring English-respondents; Hispanic English-preferring respondents; and non-Hispanic White English-respondents). SUBJECTS A total of 1,006,543 Hispanic and non-Hispanic White respondents to the Medicare 2014-2018 CAHPS surveys. RESULTS There were disparities for all Hispanic groups relative to non-Hispanic White English-respondents. Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-8 points), getting needed care (-5 points), doctor communication (-2 points), and customer service (-1 point), but better experiences for flu immunization (+2 points). Similarly, Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic English-preferring respondents for getting care quickly (-4 points) and getting needed care (-2 points). Hispanic English-preferring respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-4 points), getting needed care (-3 points), doctor communication and customer service (-2 points each), but better experience for flu immunization (+2 points). CONCLUSIONS Regardless of language preference, Hispanic people with Medicare experience disparities in patient care relative to non-Hispanic White English-preferring counterparts. Hispanic Spanish-preferring English-respondents report the worse experiences, followed by Hispanic English-preferring respondents. Hispanic Spanish-respondents experienced the least disparities of the three Hispanic language subgroups.
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Affiliation(s)
| | - Amelia M Haviland
- Carnegie Mellon University, Pittsburgh, PA
- RAND Corporation, Pittsburgh, PA
| | | | | | | | - Loida Tamayo
- Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Chalasani R, Krishnamurthy S, Suda KJ, Newman TV, Delaney SW, Essien UR. Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:709-729. [PMID: 35867522 DOI: 10.1215/03616878-10041135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.
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Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study. Cancer Causes Control 2022; 33:601-612. [PMID: 35032242 DOI: 10.1007/s10552-022-01552-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine whether racial/ethnic differences in patient experiences with care, potentially leading to underutilization of necessary care, are associated with disparities in Gleason score at diagnosis. METHODS We used the SEER-CAHPS linked dataset to identify Medicare beneficiaries who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey prior to diagnosis of prostate cancer. Independent variables included aspects of patient experiences with care captured by CAHPS surveys. We conducted survey weighted multivariable multinomial logistic regression analyses, stratified by patient race/ethnicity, to estimate associations of CAHPS measures with Gleason score at diagnosis. RESULTS Of the 4,245 patients with prostate cancer, most were non-Hispanic white (NHW) (77.6%), followed by non-Hispanic black (NHB) (8.4%), Hispanic (8.4%), and Asian (5.6%). Excellent experience with getting needed prescription drugs was associated with lower odds of Gleason scores of 7 and 8-10 in NHBs (7: OR = 0.19, 95% CI = 0.05-0.67; 8-10: OR = 0.04, 95% CI = 0.01-0.2) and lower odds of 8-10 in NHWs (OR = 0.61, 95% CI = 0.40-0.93). For NHBs, excellent primary physician ratings were associated with greater odds of a Gleason score of 8-10 (OR = 13.28, 95% CI = 1.53-115.21). CONCLUSION Patient experiences with access to care and physician relationships may influence Gleason score in different ways for patients of different racial/ethnic groups. More research, including large observational studies with greater proportions of racial/ethnic minority patients, is necessary to understand these relationships and target interventions to overcome disparities and improve patient outcomes.
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Martino SC, Mathews M, Damberg CL, Mallett JS, Orr N, Ng JH, Agniel D, Tamayo L, Elliott MN. Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries. Med Care 2021; 59:778-784. [PMID: 34054025 DOI: 10.1097/mlr.0000000000001574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Each year, about 10% of Medicare Advantage (MA) enrollees voluntarily switch to another MA contract, while another 2% voluntarily switch from MA to fee-for-service Medicare. Voluntary disenrollment from MA plans is related to beneficiaries' negative experiences with their plan, disrupts the continuity of care, and conflicts with goals to reduce Medicare costs. Little is known about racial/ethnic disparities in voluntary disenrollment from MA plans. OBJECTIVE The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity. SUBJECTS A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015. METHODS Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as predictors. Adjusted overall models added age, sex, dual eligibility, disability, and state of residence as control variables. Between-plan differences were estimated by subtracting within-plan differences from overall differences. RESULTS Adjusted rates of disenrollment were significantly (P<0.001) higher for Hispanic (+1.2 percentage points), Black (+1.2 percentage points), and API beneficiaries (+2.4 percentage points) than for Whites. Within states, all 3 racial/ethnic minority groups tended to be concentrated in higher disenrollment plans. Within plans, API beneficiaries voluntarily disenrolled considerably more often than otherwise similar White beneficiaries. CONCLUSION These findings suggest the need to address cost, information, and other factors that may create barriers to racial/ethnic minority beneficiaries' enrollment in plans with lower overall disenrollment rates.
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Affiliation(s)
| | | | | | | | | | - Judy H Ng
- National Committee for Quality Assurance, Washington, DC
| | | | - Loida Tamayo
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Kirby JB, Berdahl TA, Torres Stone RA. Perceptions of Patient-Provider Communication Across the Six Largest Asian Subgroups in the USA. J Gen Intern Med 2021; 36:888-893. [PMID: 33559065 PMCID: PMC8041938 DOI: 10.1007/s11606-020-06391-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Asians are the fastest-growing racial/ethnic minority group in the USA and many face communication barriers when seeking health care. Given that a high proportion of Asians are immigrants and have limited English proficiency, poor patient-provider communication may explain Asians' relatively low ratings of care. Though Asians are linguistically, economically, and culturally heterogeneous, research on health care disparities typically combines Asians into a single racial/ethnic category. OBJECTIVES To estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. DESIGN AND PARTICIPANTS Using a nationally representative sample of adults from the 2014-2017 Medical Expenditure Panel Survey (N = 136,836, round-specific response rates range from 72% to 98%), we estimate racial/ethnic differences in perceptions of provider communication, adjusted for English proficiency, immigration status, and sociodemographic characteristics. MAIN MEASURES The main dependent variable is a 4-item scale ranging from 0 to 100 measuring how positively patients view their health care providers' communication, adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) program. Respondents report how often their providers explain things clearly, show respect, listen carefully, and spend enough time with them. KEY RESULTS Asians, overall, had less positive perceptions of their providers' communication than either Whites or Latinxs. However, only Chinese-White differences remained after differences in English proficiency and immigration status were controlled (difference = - 2.67, 95% CI - 4.83, - 0.51). No other Asian subgroup differed significantly from Whites. CONCLUSIONS Negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. Researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care should, if possible, avoid categorizing all Asians into a single group.
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Affiliation(s)
- James B Kirby
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA.
| | - Terceira A Berdahl
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA
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Silva-Almodóvar A, Smith K, Nahata MC. Relationship between patient characteristics and number of phone calls to complete a telehealth comprehensive medication review: A cross-sectional analysis. J Am Pharm Assoc (2003) 2020; 60:923-929.e1. [PMID: 32694003 DOI: 10.1016/j.japh.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the relationship between patient characteristics and completion of telehealth comprehensive medication reviews (CMRs). DESIGN Cross-sectional analysis of a national telehealth medication therapy management program. A negative binomial regression assessed the relationship between number of phone calls to complete a CMR and age, sex, number of medications, poverty level, geographic region, limited English proficiency (LEP), years eligible for CMR services, and if a caregiver completed the CMR. SETTING AND PARTICIPANTS Patients included in the analysis were Medicare enrolled, medication therapy management eligible, and completed a CMR in 2017. Patients excluded if they were younger than 65 years, they had incomplete data, they had participated in an employer-sponsored plan, or completed a CMR with their provider. OUTCOME MEASURES Number of phone calls reflected number of outgoing phone calls needed to complete a CMR. RESULTS Analysis included 222,163 patients. Females needed 9% more calls to complete a CMR than males (incident rate ratio 1.09 [95% CI 1.08-1.10]). Adults older than 75 years compared with patients between age 65 and 74 years needed 7% fewer calls (0.93 [0.92-0.94]). Patients needing a caregiver to complete the CMR required 33% more calls than individuals who did not (1.33 [1.31-1.35]). Patients eligible for CMR services longer than 1 year required 12%-45% fewer calls to complete a CMR than recently eligible patients. A statistically significant interaction was detected between LEP and poverty quintile. CONCLUSIONS This study found that poverty level inversely affected the number of phone calls to complete a CMR between those considered LEP and English language-speakers. Female sex and caregiver presence were associated with number of phone calls needed to complete a CMR. Older age and length of CMR eligibility were inversely associated with the number of phone calls needed. Future research is warranted to evaluate whether targeted approaches may improve CMR completion rates.
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Chakravarty S. Did the Medicare Prescription Drug Program Lead to New Racial and Ethnic Disparities? Examining Long-term Changes in Prescription Drug Access among Minority Populations. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:248-260. [PMID: 32723161 DOI: 10.1080/19371918.2020.1785981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study examined whether the Medicare Part D program was associated with racial/ethnic disparities in prescription drug access among elderly individuals who reported adequate access to physicians. Using a population-based survey of New Jersey residents, a difference-in-differences model estimated elderly blacks (OR = 3.20; p = .05) and Hispanics (OR = 4.29; p = .05) had higher odds than whites of reporting prescription access problems in the post, but not the pre-Part D period. The presence of prescription insurance did not lead to a significant decrease in access problems. Part D beneficiaries are required to make complicated decisions on cost-sharing and medication choices that require active involvement by physicians and pharmacists. Lack of guidance may critically impact minorities and economically vulnerable patients and cannot be addressed by extending coverage alone.
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Affiliation(s)
- Sujoy Chakravarty
- Center for State Health Policy, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey , New Brunswick, New Jersey, USA
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14
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Costs and cost-drivers of a diagnosis of depression among adults with epilepsy in the United States. Epilepsy Behav 2019; 98:96-100. [PMID: 31301456 DOI: 10.1016/j.yebeh.2019.04.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/22/2019] [Accepted: 04/24/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the amount of direct costs associated with occurrence of depression in people with epilepsy. METHODS The Medical Expenditure Panel Survey Household Components (MEPS-HC) served as data source to identify adults (≥18 years) with epilepsy from 2003 to 2014, using the Clinical Classification Code CCC-83. Annual unadjusted per person total healthcare expenditures and individual cost components (inpatient, outpatient, prescription, emergency room, and home health) were compared between people with epilepsy and depression vs. without depression. A two-part model estimated the adjusted incremental direct cost of depression (total and individual cost components) among adults with epilepsy. The model was adjusted for sex, race/ethnicity, education, marital status, insurance status, census region, income, Charlson Comorbidities index (CCI), and year trend. RESULTS Out of a weighted 1,942,413 US adults with epilepsy, 675,037 (34.7%) had a diagnosis of depression. Annual total unadjusted per person direct cost of depression was $5290 higher in people with epilepsy vs. without [$18,776 (95% confidence interval [CI]: 16,241-21,311) vs. $13,486 (95%CI: 9780-17,191)]. Costs for outpatient and prescriptions were higher among people with epilepsy plus depression vs. without depression, but no differences were observed for inpatient, emergency room, and home health costs. In the adjusted model, total costs [$2523 (95%CI: 62-4984)], incremental annual direct costs per person for outpatient [$1940 (95%CI: 1266-2613)], prescriptions [$1285 (95%CI: 772-1798)], and emergency room [$191 (95%CI: 20-361)] were significantly higher for people with epilepsy plus depression. Unadjusted and adjusted incremental total aggregate annual direct costs of depression for people with epilepsy were $3.5 billion and $1.7 billion respectively. CONCLUSION Costs of epilepsy with presence of depression in the US are high, and primarily driven by outpatient, prescriptions, and emergency room costs.
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15
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MacCarthy S, Burkhart Q, Haviland AM, Dembosky JW, Wilson-Frederick S, Saliba D, Gaillot S, Elliott MN. Exploring Disparities in Influenza Immunization for Older Women. J Am Geriatr Soc 2019; 67:1268-1272. [PMID: 30990226 DOI: 10.1111/jgs.15887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/23/2019] [Accepted: 02/26/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES While women obtain most recommended preventive health interventions more often than men, evidence is mixed regarding influenza vaccination for older adults. Therefore, we evaluated sex differences in influenza vaccination among older adults. DESIGN Nationally representative cross-sectional survey. SETTING United States. PARTICIPANTS A total of 1 252 705 adults, aged 65 years and older, responding to 2013 to 2017 Medicare Consumer Assessment of Healthcare Providers and Systems surveys. MEASUREMENTS The dependent variable was Healthcare Effectiveness Data and Information Set self-reported influenza immunization. The primary predictor was sex. Covariates included general health status, education, race/ethnicity, and Medicare Advantage (MA; managed care) vs Fee-for-Service (FFS) coverage. RESULTS After adjusting for health status and other sociodemographic factors, women's immunization was 2% lower than men's immunization in MA, with no significant overall sex difference in FFS. Women were immunized less often than men in 95% of MA health plans, with the largest gaps in low-immunizing plans. Further analyses revealed variation in sex differences by health status, education, and race/ethnicity in both MA and FFS. Notably in MA, women in poor health were immunized less often than men in similar health (-4%; P < .001). Black women were immunized much less often than black men in both MA and FFS (-5%; P < .001 for each). Hispanic women were immunized less often than Hispanic men in MA (-4%; P < .001) but not within FFS. CONCLUSION Women in MA experience small disparities overall in influenza immunization, with larger disparities for black and Hispanic women. Providers and MA plans should increase efforts to recommend and monitor immunization for older women, especially black and Hispanic women and those in poor health. Given the potential to reduce morbidity and mortality, equitable access to a critical preventive health service, such as influenza immunization, is crucial for all older adults.
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Affiliation(s)
| | - Q Burkhart
- RAND Corporation, Santa Monica, California
| | - Amelia M Haviland
- Heinz College, Carnegie Mellon University, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | - Debra Saliba
- RAND Corporation, Santa Monica, California.,Borun Center, University of California, Los Angeles.,Veterans Affairs Geriatric Research Education and Clinical Center, Los Angeles, California
| | - Sarah Gaillot
- Office of Minority Health, Centers for Medicare and Medicaid Services, Baltimore, Maryland.,Center for Medicare, Centers for Medicare and Medicaid Services, Baltimore, Maryland
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16
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Quigley DD, Elliott MN, Hambarsoomian K, Wilson-Frederick SM, Lehrman WG, Agniel D, Ng JH, Goldstein EH, Giordano LA, Martino SC. Inpatient care experiences differ by preferred language within racial/ethnic groups. Health Serv Res 2019; 54 Suppl 1:263-274. [PMID: 30613960 PMCID: PMC6341216 DOI: 10.1111/1475-6773.13105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups. Data Source 2014‐2015 HCAHPS survey data. Study Design We compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within applicable subsets of five racial/ethnic groups (Hispanics, Asian/Pacific Islanders, American Indian/Alaska Natives, Blacks, and Whites). We measured patient‐mix adjusted overall, between‐ and within‐hospital differences in patient experience by language, using linear regression. Data Collection Methods Surveys from 5 480 308 patients discharged from 4517 hospitals 2014‐2015. Principal Findings Within each racial/ethnic group, mean reported experiences for non‐English‐preferring patients were almost always worse than their English‐preferring counterparts. Language differences were largest and most consistent for Care Coordination. Within‐hospital differences by language were often larger than between‐hospital differences and were largest for Care Coordination. Where between‐hospital differences existed, non‐English‐preferring patients usually attended hospitals whose average patient experience scores for all patients were lower than the average scores for the hospitals of their English‐preferring counterparts. Conclusions Efforts should be made to increase access to better hospitals for language minorities and improve care coordination and other facets of patient experience in hospitals with high proportions of non‐English‐preferring patients, focusing on cultural competence and language‐appropriate services.
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Affiliation(s)
| | | | | | | | | | | | - Judy H Ng
- National Committee for Quality Assurance, Washington, District of Columbia
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17
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Haas A, Elliott MN, Dembosky JW, Adams JL, Wilson-Frederick SM, Mallett JS, Gaillot S, Haffer SC, Haviland AM. Imputation of race/ethnicity to enable measurement of HEDIS performance by race/ethnicity. Health Serv Res 2018; 54:13-23. [PMID: 30506674 DOI: 10.1111/1475-6773.13099] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To improve an existing method, Medicare Bayesian Improved Surname Geocoding (MBISG) 1.0 that augments the Centers for Medicare & Medicaid Services' (CMS) administrative measure of race/ethnicity with surname and geographic data to estimate race/ethnicity. DATA SOURCES/STUDY SETTING Data from 284 627 respondents to the 2014 Medicare CAHPS survey. STUDY DESIGN We compared performance (cross-validated Pearson correlation of estimates and self-reported race/ethnicity) for several alternative models predicting self-reported race/ethnicity in cross-sectional observational data to assess accuracy of estimates, resulting in MBISG 2.0. MBISG 2.0 adds to MBISG 1.0 first name, demographic, and coverage predictors of race/ethnicity and uses a more flexible data aggregation framework. DATA COLLECTION/EXTRACTION METHODS We linked survey-reported race/ethnicity to CMS administrative and US census data. PRINCIPAL FINDINGS MBISG 2.0 removed 25-39 percent of the remaining MBISG 1.0 error for Hispanics, Whites, and Asian/Pacific Islanders (API), and 9 percent for Blacks, resulting in correlations of 0.88 to 0.95 with self-reported race/ethnicity for these groups. CONCLUSIONS MBISG 2.0 represents a substantial improvement over MBISG 1.0 and the use of CMS administrative data on race/ethnicity alone. MBISG 2.0 is used in CMS' public reporting of Medicare Advantage contract HEDIS measures stratified by race/ethnicity for Hispanics, Whites, API, and Blacks.
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Affiliation(s)
- Ann Haas
- RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | - John L Adams
- Kaiser Permanente Center for Effectiveness and Safety Research, Pasadena, California
| | | | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Samuel C Haffer
- U.S. Equal Employment Opportunity Commission, Washington, District of Columbia
| | - Amelia M Haviland
- RAND Corporation, Pittsburgh, Pennsylvania.,Carnegie Mellon University, Pittsburgh, Pennsylvania
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18
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Fenton AT, Burkhart Q, Weech-Maldonado R, Haviland AM, Dembosky JW, Shih R, Wilson-Frederick SM, Gaillot S, Elliott MN. Geographic context of black-white disparities in Medicare CAHPS patient experience measures. Health Serv Res 2018; 54 Suppl 1:275-286. [PMID: 30467831 PMCID: PMC6341209 DOI: 10.1111/1475-6773.13091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine whether black-white patient experience disparities vary by geography and within-county contextual factors. DATA SOURCES 321 300 Medicare beneficiaries responding to the 2015-2016 Medicare Consumer Assessment of Health care Providers and Systems (MCAHPS) Surveys; 2010 Census data for several within-county contextual factors. STUDY DESIGN Mixed-effects regression models predicted three MCAHPS patient experience measures for black and white beneficiaries from geographic random effects, contextual fixed effects, and beneficiary-level case-mix adjustors. PRINCIPAL FINDINGS Black-white disparities in patient experiences were smaller in counties with higher average patient experiences. Black-white disparities in patient experiences were not associated with county-level poverty or racial segregation. However, county racial segregation and some measures of poverty were significantly associated with all beneficiaries' level of health care access. Getting Needed Care scores were higher with greater racial segregation, while Getting Care Quickly scores were lower with higher poverty and racial segregation. CONCLUSIONS Efforts to reduce black-white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low-income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.
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Affiliation(s)
| | - Q Burkhart
- RAND Corporation, Santa Monica, California
| | | | - Amelia M Haviland
- Carnegie Mellon University, Pittsburgh, Pennsylvania.,RAND Corporation, Pittsburgh, Pennsylvania
| | | | | | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
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19
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Lind KE, Hildreth K, Lindrooth R, Morrato E, Crane LA, Perraillon MC. Effect of Medicare Part D on Ethnoracial Disparities in Antidementia Medication Use. J Am Geriatr Soc 2018; 66:1760-1767. [PMID: 30095169 DOI: 10.1111/jgs.15494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine ethnoracial disparities in antidementia medication use, accounting for implementation of Part D, and to evaluate the role of prescription drug coverage as a cause of antidementia medication disparities. DESIGN Rotating panel of Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey from 2003 to 2013. SETTING Nationally representative sample of Medicare fee-for-service (FFS) beneficiaries with dementia. PARTICIPANTS Community-dwelling FFS Medicare beneficiaries with dementia (N=4,304). MEASUREMENTS Antidementia medication use, defined as at least one prescription fill in a given year. RESULTS Unadjusted antidementia medication use was 10-percentage points lower for ethnoracial minority beneficiaries before Part D was implemented in 2006 (p=.01). This difference was attenuated after adjusting for demographic and socioeconomic factors (6-percentage points; p=.10). Part D was associated with a 6-percentage point increase in use (p<.01). The increase in use associated with Part D was higher although not statistically significantly so in ethnoracial minority beneficiaries (8-percentage points, p=.08). Analyses of each ethnoracial group found a significant effect of Part D only in Hispanic/Latino beneficiaries (18-percentage points; p<.01, adjusted). CONCLUSION Antidementia medication disparities were reduced with expanded prescription drug coverage through Medicare Part D. Increases in antidementia medication use for minority beneficiaries started after Part D was implemented, with the largest increases in use observed in Hispanic/Latino beneficiaries.
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Affiliation(s)
- Kimberly E Lind
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kerry Hildreth
- Department of Geriatrics, School of Medicine, University of Colorado, Aurora, Colorado
| | - Richard Lindrooth
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Elaine Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado
| | - Lori A Crane
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Marcelo Coca Perraillon
- Department of Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado
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20
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Speaking Up and Walking Out: Are Vulnerable Patients Less Likely to Disagree With or Change Doctors? Med Care 2018; 56:749-754. [PMID: 29901494 DOI: 10.1097/mlr.0000000000000936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disparities in clinical process-of-care and patient experiences are well documented for Medicare beneficiaries with ≥1 social risk factors. If such patients are less willing to express disagreement with their doctors or change doctors when dissatisfied, these behaviors may play a role in observed disparities. OBJECTIVE To investigate the association between social risk factors and self-reported likelihood of disagreeing with or changing doctors if dissatisfied among the Medicare fee-for-service population. SUBJECTS Fee-for-service beneficiaries (N=96,317) who responded to the 2014 Medicare Consumer Assessment of Healthcare Providers and Systems survey. Subgroups were defined based on age, education, income, and race/ethnicity. METHODS Respondents reported how likely they would be to express disagreement with their doctors and change doctors if dissatisfied (1=very unlikely to 4=very likely; rescaled to 0-100 points). We fit mixed-effect linear regression models predicting these outcomes from social risk factors, controlling for health status and geographic location. RESULTS Beneficiaries who were older, less educated, and had lower incomes were least inclined to express disagreement or change doctors (P<0.001). Compared with non-Hispanic whites, Asian/Pacific Islander (-9.5) and Hispanic (-3.6) beneficiaries said they would be less likely, and black (+2.8) beneficiaries more likely, to express disagreement. Asian/Pacific Islander (-8.7), Hispanic (-5.9), and American Indian/Alaska Native (-3.8) beneficiaries were less inclined than non-Hispanic whites to change doctors (P<0.01). DISCUSSION Reduction in health care disparities may be achieved if doctors and advocates encourage vulnerable patients to express their concerns and perspectives and if communities and caregivers provide support for changing providers when care is poor.
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21
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Bakk L, Cadet TJ. Awareness of the Medicare Part D Low-Income Subsidy among Older non-Hispanic Blacks and Hispanics. SOCIAL WORK IN PUBLIC HEALTH 2018; 33:250-258. [PMID: 29694273 DOI: 10.1080/19371918.2018.1462285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Using nationally representative data from the Health and Retirement Study, this study examined (1) whether awareness of the Medicare Part D Low-Income Subsidy (LIS) varies by race and ethnicity among beneficiaries age 65 and older (N = 1,504), and (2) the impact of factors associated with health benefits knowledge and need for assistance on LIS awareness. Logistic regression results showed that compared with older non-Hispanic Whites, older non-Hispanic Blacks (odds ratio [OR] = .61, p < .001) and Hispanics (OR = .55, p < .01) were less likely to be aware of the LIS. Ethnic differences in LIS awareness were largely explained by language or Spanish-speaking preference (OR = 1.07, p = .808). However, accounting for demographics, health and socioeconomic status, and language did not reduce racial disparities (OR = .63, p < .01). Differences in LIS awareness among racial and ethnic minority groups highlight the need for culturally and linguistically sensitive community-based education, communication, programs, and services that increase knowledge of and access to this critical support.
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Affiliation(s)
- Louanne Bakk
- a School of Social Work , University at Buffalo , Buffalo , NY, USA
| | - Tamara J Cadet
- b School of Social Work , Simmons College , Boston , MA, USA
- c Harvard School of Dental Medicine , Boston , MA, USA
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22
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You K, Strawderman RL, Li Y. Ethnic Disparities in Medicare Part D Satisfaction and Intention to Switch Plans. J Aging Soc Policy 2017; 29:297-310. [PMID: 27880087 DOI: 10.1080/08959420.2016.1261569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Medicare Part D has been successful in providing affordable prescription drug coverage with relatively high levels of beneficiary reported satisfaction. We use nationally representative survey data to examine whether racial/ethnic disparities exist in reported Part D satisfaction and plan evaluations. Compared to non-Hispanic White Medicare beneficiaries, Hispanic beneficiaries are considerably more likely to report to switch to a new plan in the next year and, among beneficiaries auto-enrolled in a Part D plan, are less likely to be very satisfied with the currently enrolled plan. The findings of ethnic disparities in both Medicare Part D plan satisfaction and the intent to switch plans call for future quality and equity improvement efforts to address these disparities.
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Affiliation(s)
- Kai You
- a PhD Student, Department of Economics , University at Albany, State University of New York , Albany , New York , USA
| | - Robert L Strawderman
- b Professor and Chair, Department of Biostatistics and Computational Biology , University of Rochester Medical Center , Rochester , New York , USA
| | - Yue Li
- c Associate Professor, Department of Public Health Sciences , Division of Health Policy and Outcomes Research, University of Rochester Medical Center , Rochester , New York , USA
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23
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Damberg CL, Elliott MN, Ewing BA. Pay-for-performance schemes that use patient and provider categories would reduce payment disparities. Health Aff (Millwood) 2017; 34:134-42. [PMID: 25561654 DOI: 10.1377/hlthaff.2014.0386] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Providers that care for disproportionate numbers of disadvantaged patients tend to perform less well than other providers on quality measures commonly used in pay-for-performance programs. This can lead to the undesired effect of redistributing resources away from providers that most need them to improve care. We present a new pay-for-performance scheme that retains the motivational aspects of standard incentive designs while avoiding undesired effects. We tested an alternative incentive payment approach that started with a standard incentive payment allocation but then "post-adjusted" provider payments using predefined patient or provider characteristics. We evaluated whether such an approach would mitigate the negative effects of redistributions of payments across provider organizations in California with disparate patient populations. The post-adjustment approach nearly doubled payments to disadvantaged provider organizations and greatly reduced payment differentials across provider organizations according to patients' income, race/ethnicity, and region. The post-adjustment of payments could be a useful supplement to paying for improvement, aligning the goals of disparity reduction and quality improvement.
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Affiliation(s)
- Cheryl L Damberg
- Cheryl L. Damberg is the RAND Distinguished Chair in Health Care Payment Policy and a principal senior researcher in the Health Program at the RAND Corporation in Santa Monica, California
| | - Marc N Elliott
- Marc N. Elliott is the RAND Distinguished Chair in Statistics and a principal senior researcher in the Health Program at RAND in Santa Monica
| | - Brett A Ewing
- Brett A. Ewing is a statistical project associate in economics, sociology, and statistics at RAND in Santa Monica
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24
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Jamison JJ, Wang J, Surbhi S, Adams S, Solomon D, Hohmeier KC, McDonough S, Eoff JC. Impact of Medicare Part D on Racial and Ethnic Minorities. DIVERSITY AND EQUALITY IN HEALTH AND CARE 2016; 13:326-333. [PMID: 28008353 PMCID: PMC5166707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Prior to the implementation of Medicare Part D in the United States, inequalities were found to exist in the use of medications between minority and white beneficiaries. Despite improvements in medication affordability after Medicare Part D implementation, it is still not clear whether the characteristics of the program have improved drug utilization patterns among minorities to the same degree as whites. This review aims to determine whether there were barriers for Medicare Part D to realize its potential to improve prescription drug utilization patterns among minorities. METHODS Google Scholar, PubMed, Sciencedirect and Scopus were used to conduct a comprehensive search of the literature published since 2003 when the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was passed, which authorized the establishment of the Part D program. All studies and documents related to the effects of Medicare Part D on minorities were included to present a relatively comprehensive review on the topic. RESULTS Evidence indicated that minorities are not equally benefiting from Medicare Part D prescription drug coverage compared to whites. Examples of characteristics of Medicare Part D that caused significant racial differences in drug utilization include the donut hole, the complexity and number of drug plans, and drug utilization management strategies. CONCLUSION Medicare Part D has increased access to prescription medications for the elderly. However, continued analysis and research of drug utilization patterns among minorities should be conducted to ensure that all enrollees regardless of race are benefiting equally from Medicare Part D. Identification of these barriers can provide insights on how to improve the program to allow minorities to benefit equally from the Medicare Part D program and remove health inequalities.
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Affiliation(s)
- JoEllen Jarrett Jamison
- The University of Tennessee Health Science Center, College of Pharmacy, Pharmacy Student, 881 Madison Avenue, Memphis, TN 38163
| | - Junling Wang
- Professor, Health Outcomes and Policy Research, Department of Clinical Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 221, Memphis, TN 38163
| | - Satya Surbhi
- Graduate Research Assistant/Ph.D. Student, Health Outcomes and Policy Research, The University of Tennessee Health Science Center College of Graduate Health Sciences, 956 Court Avenue, Room D224, Memphis, TN 38163
| | - Samantha Adams
- The University of Tennessee Health Science Center, College of Pharmacy, Pharmacy Student, 881 Madison Avenue, Room 221, Memphis, TN 38163
| | - David Solomon
- Department of Clinical Pharmacy, The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Memphis, TN 38163
| | - Kenneth C. Hohmeier
- Assistant Professor of Clinical Pharmacy, Director of Community Affairs, Department of Clinical Pharmacy, The University of Tennessee College of Pharmacy, 193 Polk Avenue, Room 2D, Nashville, TN 37210
| | - Sharon McDonough
- Coordinator of Assessment and Assistant Professor, University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 252, Memphis, TN 38163
| | - James C. Eoff
- The University of Tennessee Health Science Center College of Pharmacy, 881 Madison Avenue, Room 242, Memphis, TN 38163
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25
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Evidence-Based Policy Making: Assessment of the American Heart Association’s Strategic Policy Portfolio. Circulation 2016; 133:e615-53. [DOI: 10.1161/cir.0000000000000410] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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26
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Hussein M, Waters TM, Chang CF, Bailey JE, Brown LM, Solomon DK. Impact of Medicare Part D on Racial Disparities in Adherence to Cardiovascular Medications Among the Elderly. Med Care Res Rev 2015; 73:410-36. [PMID: 26577228 DOI: 10.1177/1077558715615297] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/12/2015] [Indexed: 01/13/2023]
Abstract
Medicare Part D improved medication adherence among the elderly, but to date, its effect on disparities in adherence remains unknown. We estimated Part D impact on racial/ethnic disparities in adherence to cardiovascular medications among seniors, using pooled data from the Medical Expenditure Panel Survey (2002-2010) on 14,221 Medicare recipients (65+ years) and 3,456 near-elderly controls (60-64 years). Study sample included White, Black, or Hispanic respondents who used at least one cardiovascular medication. Twelve-month adherence was measured as having an overall proportion of days covered ≥80%. Adherence disparities were defined according to the Institute of Medicine framework. Using difference-in-differences logistic regression, we found Part D to be associated with a 16-percentage-point decrease in the White-Hispanic disparity in overall adherence among seniors, net of the change among controls. Black-White disparities worsened only among men, by 21 percentage points. Increasing access and improving quality of medication use among disadvantaged seniors should remain a policy priority.
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Affiliation(s)
- Mustafa Hussein
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - James E Bailey
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - David K Solomon
- The University of Tennessee Health Science Center, Memphis, TN, USA
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27
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Smith LM, Anderson WL, Kenyon A, Kinyara E, With SK, Teichman L, Dean-Whittaker D, Goldstein E. Racial and Ethnic Disparities in Patients' Experience With Skilled Home Health Care Services. Med Care Res Rev 2015; 72:756-74. [PMID: 26238122 DOI: 10.1177/1077558715597398] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/13/2015] [Indexed: 11/16/2022]
Abstract
Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS(®) data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies.
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Affiliation(s)
| | | | - Anne Kenyon
- RTI International, Research Triangle Park, NC, USA
| | | | - Sarah K With
- RTI International, Research Triangle Park, NC, USA
| | - Lori Teichman
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
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Weech-Maldonado R, Elliott MN, Adams JL, Haviland AM, Klein DJ, Hambarsoomian K, Edwards C, Dembosky JW, Gaillot S. Do Racial/Ethnic Disparities in Quality and Patient Experience within Medicare Plans Generalize across Measures and Racial/Ethnic Groups? Health Serv Res 2015; 50:1829-49. [PMID: 25757356 DOI: 10.1111/1475-6773.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine how similar racial/ethnic disparities in clinical quality (Healthcare Effectiveness Data and Information Set [HEDIS]) and patient experience (Consumer Assessment of Healthcare Providers and Systems [CAHPS]) measures are for different measures within Medicare Advantage (MA) plans. DATA SOURCES/STUDY SETTING 5.7 million/492,495 MA beneficiaries with 2008-2009 HEDIS/CAHPS data. STUDY DESIGN Binomial (HEDIS) and linear (CAHPS) hierarchical mixed models generated contract estimates for HEDIS/CAHPS measures for Hispanics, blacks, Asian-Pacific Islanders, and whites. We examine the correlation of within-plan disparities for HEDIS and CAHPS measures across measures. PRINCIPAL FINDINGS Plans with disparities for a given minority group (vs. whites) for a particular measure have a moderate tendency for similar disparities for other measures of the same type (mean r = 0.51/.21 and 53/34 percent positive and statistically significant for CAHPS/HEDIS). This pattern holds to a lesser extent for correlations of CAHPS disparities and HEDIS disparities (mean r = 0.05/0.14/0.23 and 4.4/5.6/4.4 percent) positive and statistically significant for blacks/Hispanics/API. CONCLUSIONS Similarities in CAHPS and HEDIS disparities across measures might reflect common structural factors, such as language services or provider incentives, affecting several measures simultaneously. Health plan structural changes might reduce disparities across multiple measures.
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Affiliation(s)
- Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL
| | | | - John L Adams
- Center for Effectiveness and Research, Kaiser Permanente, Pasadena, CA
| | - Amelia M Haviland
- H. John Heinz III College of Public Policy and Management, Carnegie Mellon University, Pittsburgh, PA
| | - David J Klein
- Department of Pediatrics, Boston Children's Hospital, Boston, MA
| | | | | | | | - Sarah Gaillot
- Division of Consumer Assessment & Plan Performance, Centers for Medicare & Medicaid Services, Baltimore, MD
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Price RA, Haviland AM, Hambarsoomian K, Dembosky JW, Gaillot S, Weech-Maldonado R, Williams MV, Elliott MN. Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract? Health Serv Res 2015; 50:1649-87. [PMID: 25752334 DOI: 10.1111/1475-6773.12292] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts. DATA SOURCES/STUDY SETTING Exactly 492,495 Medicare beneficiaries responding to the 2008-2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. DATA COLLECTION/EXTRACTION METHODS Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects. PRINCIPAL FINDINGS As a contract's proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions. CONCLUSIONS The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores.
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Affiliation(s)
| | | | | | | | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, Baltimore, MD
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Adams AS, Soumerai SB, Zhang F, Gilden D, Burns M, Huskamp HA, Trinacty C, Alegria M, LeCates RF, Griggs JJ, Ross-Degnan D, Madden JM. Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression. Clin Ther 2015; 37:597-609. [PMID: 25620439 DOI: 10.1016/j.clinthera.2014.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/03/2014] [Accepted: 12/16/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Black patients with diabetes are at greater risk of underuse of antidepressants even when they have equal access to health insurance. This study aimed to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on existing black-white disparities in antidepressant treatment rates among patients with diabetes and comorbid depression. METHODS We used an interrupted time series with comparison series design and a 5% representative sample of all fee-for-service Medicare and Medicaid dual enrollees to evaluate the removal of drug caps on monthly antidepressant treatment rates. We evaluated the impact of drug cap removal on racial gaps in treatment by modeling the month-to-month white-black difference in use within age strata (younger than 65 years of age or 65 years of age or older). We compared adult dual enrollees with diabetes and comorbid depression living in states with strict drug caps (n = 221) and those without drug caps (n = 1133) before the policy change. Our primary outcome measures were the proportion of patients with any antidepressant use per month and the mean standardized monthly doses (SMDs) of antidepressants per month. FINDINGS The removal of drug caps in strict drug cap states was associated with a sudden increase in the proportion of patients treated for depression (4 percentage points; 95% CI, 0.03-0.05, P < 0.0001) and in the intensity of antidepressant use (SMD: 0.05; 95% CI, 0.03-0.07, P < 0.001). Although antidepressant treatment rates increased for both white and black patients, the white-black treatment gap increased immediately after Part D (0.04 percentage points; 95% CI, 0.01-0.08) and grew over time (0.04 percentage points per month; 95% CI, 0.002-0.01; P < 0.001). IMPLICATIONS Policies that remove financial barriers to medications may increase depression treatment rates among patients with diabetes overall while exacerbating treatment disparities. Tailored outreach may be needed to address nonfinancial barriers to mental health services use among black patients with diabetes.
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Affiliation(s)
- Alyce S Adams
- Division of Research, Kaiser Permanente, Oakland, California.
| | - Stephen B Soumerai
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | | | - Marguerite Burns
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Connie Trinacty
- Center for Health Research, Kaiser Permanente, Honolulu, Hawaii
| | - Margarita Alegria
- Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, Somerville, Massachusetts
| | - Robert F LeCates
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Jennifer J Griggs
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Jeanne M Madden
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
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Zissimopoulos J, Joyce GF, Scarpati LM, Goldman DP. Did Medicare Part D reduce disparities? THE AMERICAN JOURNAL OF MANAGED CARE 2015; 21:119-128. [PMID: 25880361 PMCID: PMC4405127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES We assessed whether Medicare Part D reduced disparities in access to medication. STUDY DESIGN Secondary data analysis of a 20% sample of Medicare beneficiaries, using Parts A and B medical claims from 2002 to 2008 and Part D drug claims from 2006 to 2008. METHODS We analyzed the medication use of Hispanic, black, and white beneficiaries with diabetes before and after reaching the Part D coverage gap, and compared their use with that of race-specific reference groups not exposed to the loss in coverage. Unadjusted difference-in-difference results were validated with multivariate regression models adjusted for demographics, comorbidities, and zip code-level household income used as a proxy for socioeconomic status. RESULTS The rate at which Hispanics reduced use of diabetes-related medications in the coverage gap was twice as high as whites, while blacks decreased their use of diabetes-related medications by 33% more than whites. The reduction in medication use was correlated with drug price. Hispanics and blacks were more likely than whites to discontinue a therapy after reaching the coverage gap but more likely to resume once coverage restarted. Hispanics without subsidies and living in low-income areas reduced medication use more than similar blacks and whites in the coverage gap. CONCLUSIONS We found that the Part D coverage gap is particularly disruptive to minorities and those living in low-income areas. The implications of this work suggest that protecting the health of vulnerable groups requires more than premium subsidies. Patient education may be a first step, but more substantive improvements in adherence may require changes in healthcare delivery.
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Affiliation(s)
- Julie Zissimopoulos
- Assistant Professor and Associate Director, Schaeffer Center for Health Policy and Economics, University of Southern California, Verna & Peter Dauterive Hall (VPD) 635 Downey Way Los Angeles, CA 90089-3333. Tel: 213-821-7947; Fax: 213-740-3460
| | - Geoffrey F. Joyce
- Associate Professor and Director of Health Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, Verna & Peter Dauterive Hall (VPD) 635 Downey Way Los Angeles, CA 90089-3333
| | - Lauren M. Scarpati
- Doctoral Student in Economics, Schaeffer Center for Health Policy and Economics, University of Southern California, Verna & Peter Dauterive Hall (VPD) 635 Downey Way Los Angeles, CA 90089-3333
| | - Dana P. Goldman
- Schaeffer Chair and Director, Schaeffer Center for Health Policy and Economics, University of Southern California, Verna & Peter Dauterive Hall (VPD) 635 Downey Way Los Angeles, CA 90089-3333
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Chakravarty S, Gaboda D, DeLia D, Cantor JC, Nova J. Impact of Medicare Part D on coverage, access, and disparities among new jersey seniors. Med Care Res Rev 2014; 72:127-48. [PMID: 25547107 DOI: 10.1177/1077558714563762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors used a population-based survey of New Jersey residents to assess outcomes associated with implementation of the Medicare Part D program. Between 2001 and 2009, there was a 24% increase in prescription drug coverage among elderly individuals, but also an increase in cost-related access problems. Compared with the pre-Part D period, seniors reporting access problems post-Part D were less likely to be uninsured and more likely to be publicly insured. Cost-related access disparities among elderly Blacks and Hispanics relative to elderly Whites persisted from 2001 to 2009, and were partly driven by ongoing disparities related to low income. Such cost-based access problems 3 years into implementation implies that they are not transitory and may reflect inadequate subsidy levels alongside the importance of physician advice about prescriptions in ensuring low-cost medication options for vulnerable patients. Finally, the findings, may also reflect success in enrolling high-need seniors into Part D.
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Affiliation(s)
| | | | | | | | - Jose Nova
- Rutgers University, New Brunswick, NJ, USA
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Adams AS, Madden JM, Zhang F, Soumerai SB, Gilden D, Griggs J, Trinacty CM, Bishop C, Ross-Degnan D. Changes in use of lipid-lowering medications among black and white dual enrollees with diabetes transitioning from Medicaid to Medicare Part D drug coverage. Med Care 2014; 52:695-703. [PMID: 24988304 PMCID: PMC4135389 DOI: 10.1097/mlr.0000000000000159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of lipid-lowering agents is suboptimal among dual enrollees, particularly blacks. OBJECTIVES To determine whether the removal of restrictive drug caps under Medicare Part D reduced racial differences among dual enrollees with diabetes. RESEARCH DESIGN An interrupted time series with comparison series design (ITS) cohort study. SUBJECTS A total of 8895 black and white diabetes patients aged 18 years and older drawn from a nationally representative sample of fee-for-service dual enrollees (January 2004-December 2007) in states with and without drug caps before Part D. MEASURES We examined the monthly (1) proportion of patients with any use of lipid-lowering therapies; and (2) intensity of use. Stratification measures included age (less than 65, 65 y and older), race (white vs. black), and sex. RESULTS At baseline, lipid-lowering drug use was higher in no drug cap states (drug cap: 54.0% vs. nondrug cap: 66.8%) and among whites versus blacks (drug cap: 58.5% vs. 44.9%, no drug cap: 68.4% vs. 61.9%). In strict drug cap states only, Part D was associated with an increase in the proportion with any use [nonelderly: +0.07 absolute percentage points (95% confidence interval, 0.06-0.09), P<0.001; elderly: +0.08 (0.06-0.10), P<0.001] regardless of race. However, we found no evidence of a change in the white-black gap in the proportion of users despite the removal of a significant financial barrier. CONCLUSIONS Medicare Part D was associated with increased use of lipid-lowering drugs, but racial gaps persisted. Understanding non-coverage-related barriers is critical in maximizing the potential benefits of coverage expansions for disparities reduction.
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Affiliation(s)
- Alyce S. Adams
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, phone: (510) 891-5921; fax: (510) 891-3606
| | - Jeanne M. Madden
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 133 Brookline Avenue, 6 Floor, Boston, MA 02215, phone: (617) 509-9953, fax: 617-859-9853
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, phone: 617- 509-9962, fax: 617- 859-9853
| | - Stephen B. Soumerai
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, phone: 617- 509-9942, fax: 617- 859-9853
| | - Dan Gilden
- Jen Associates, Inc., 5 Bigelow Street, Cambridge, MA 02139, phone: 617-868-5578, fax: 617-868-7963
| | - Jennifer Griggs
- Department of Internal Medicine, University of Michigan, North Ingalls Building, 300 North Ingalls, Room NI3A22, Ann Arbor, MI 48109-5419, phone: 734-647-9912, fax: 734.936.8944
| | - Connie Mah Trinacty
- Kaiser Permanente Center for Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI 96817, office: 808-432-5555 x1426, mobile: 808-285-6414, fax: 808-432-5121
| | - Christine Bishop
- The Heller School for Social Policy and Management, Brandeis University. Heller-Brown Building, #212, 415 South Street MS 035, Waltham, MA 02454-9110, phone: 781-736-3942, fax: none
| | - Dennis Ross-Degnan
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, phone: 617- 509-9920, fax: 617- 509-9847
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Grams ME, Matsushita K, Sang Y, Estrella MM, Foster MC, Tin A, Kao WHL, Coresh J. Explaining the racial difference in AKI incidence. J Am Soc Nephrol 2014; 25:1834-41. [PMID: 24722442 PMCID: PMC4116065 DOI: 10.1681/asn.2013080867] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/23/2013] [Indexed: 12/23/2022] Open
Abstract
African Americans face higher risk of AKI than Caucasians. The extent to which this increased risk is because of differences in clinical, socioeconomic, or genetic risk factors is unknown. We evaluated 10,588 African-American and Caucasian participants in the Atherosclerosis Risk in Communities study, a community-based prospective cohort of middle-aged individuals. Participants were followed from baseline study visit (1996-1999) to first hospitalization for AKI (defined by billing code), ESRD, death, or December 31, 2010. African-American participants were slightly younger (61.7 versus 63.1 years, P<0.001), were more often women (64.5% versus 53.2%, P<0.001), and had higher baseline eGFR compared with Caucasians. Annual family income, education level, and prevalence of health insurance were lower among African Americans than Caucasians. The unadjusted incidence of hospitalized AKI was 7.4 cases per 1000 person-years among African Americans and 5.8 cases per 1000 person-years among Caucasians (P=0.002). The elevated risk of AKI among African Americans persisted after adjustment for demographics, cardiovascular risk factors, kidney markers, and time-varying number of hospitalizations (adjusted hazard ratio, 1.20; 95% confidence interval [95% CI], 1.01 to 1.43; P=0.04); however, accounting for differences in income and/or insurance by race attenuated the association (P>0.05). High-risk APOL1 variants did not associate with AKI among African Americans (demographic-adjusted hazard ratio, 1.07; 95% CI, 0.69 to 1.65; P=0.77). In summary, the higher risk of AKI among African Americans may be related to disparities in socioeconomic status.
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Affiliation(s)
- Morgan E Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; andDepartments of Epidemiology and
| | | | | | - Michelle M Estrella
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | | | | | | | - Josef Coresh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; andDepartments of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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Choudhry NK, Bykov K, Shrank WH, Toscano M, Rawlins WS, Reisman L, Brennan TA, Franklin JM. Eliminating Medication Copayments Reduces Disparities In Cardiovascular Care. Health Aff (Millwood) 2014; 33:863-70. [DOI: 10.1377/hlthaff.2013.0654] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Niteesh K. Choudhry
- Niteesh K. Choudhry ( ) is an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, and an associate professor at Harvard Medical School, both in Boston, Massachusetts
| | - Katsiaryna Bykov
- Katsiaryna Bykov is a staff epidemiologist in the Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital
| | - William H. Shrank
- William H. Shrank was an assistant professor of medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital at the time this work was done, and is now chief scientific officer of CVS/Caremark, in Woonsocket, Rhode Island
| | - Michele Toscano
- Michele Toscano is program manager for the Racial and Ethnic Equality Initiative, Aetna, in Hartford, Connecticut
| | - Wayne S. Rawlins
- Wayne S. Rawlins is national medical director for the Racial and Ethnic Equality Initiative, Aetna
| | | | | | - Jessica M. Franklin
- Jessica M. Franklin is an instructor in medicine, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital and Harvard Medical School
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Weinick R, Haviland A, Hambarsoomian K, Elliott MN. Does the racial/ethnic composition of Medicare Advantage plans reflect their areas of operation? Health Serv Res 2013; 49:526-45. [PMID: 24032551 DOI: 10.1111/1475-6773.12100] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess the extent to which the racial/ethnic composition of Medicare Advantage (MA) plans reflects the composition of their areas of operation, given the potential incentives created by the Centers for Medicare & Medicaid Services' Quality Bonus Payments for such plans to avoid enrolling racial/ethnic minority beneficiaries. DATA SOURCES/STUDY SETTING 2009 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey and administrative data from the Medicare Enrollment Database. DATA COLLECTION/EXTRACTION METHODS We defined each plan's area of operation as all counties in which it had MA enrollees, and we created a matrix of race/ethnicity by plan by county of residence to assess the racial/ethnic distribution of each plan's enrollees in comparison with the racial/ethnic composition of MA beneficiaries in its operational area. PRINCIPAL FINDINGS There is little evidence that health plans are selectively underenrolling blacks, Latinos, or Asians to a substantial degree. A small but potentially important subset of plans disproportionately serves minority beneficiaries. CONCLUSIONS These findings provide a baseline profile that will enable crucial ongoing monitoring to assess how the implementation of Quality Bonus Payments may affect MA plan coverage of minority populations.
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Dismuke CE, Egede LE. Medicare part D prescription drug program: benefits, unintended consequences and impact on health disparities. J Gen Intern Med 2013; 28:860-1. [PMID: 23539284 PMCID: PMC3682045 DOI: 10.1007/s11606-013-2423-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Clara E. Dismuke
- />Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Charleston, SC USA
- />Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC USA
- />Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, P.O. Box 250593, Charleston, SC 29425-0593 USA
| | - Leonard E. Egede
- />Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VAMC, Charleston, SC USA
- />Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC USA
- />Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, Room 280H, P.O. Box 250593, Charleston, SC 29425-0593 USA
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