Strengthening the health services research to reduce racial and ethnic disparities in health care

Primary health care access, continuity, and cost among pediatric patients with obesity hypertension

The purpose of this study was to determine how comorbid medical conditions, and the need for early pharmacological intervention, race, gender, and age are associated with service utilization and primary health care costs. From a statewide Medicaid database, medical and pharmacy claims for 10 calendar years (January 1995 to December 2004) were extracted to identify a cohort of children, ages 0 to 17, with (n = 552) and without (n = 2943) a diagnosis of both obesity and primary hypertension. Pediatric African American patients had more diagnosed medical conditions, significantly fewer visits during their first year of primary health care (chi2, 161.16; p < or = .0001) and significantly lower total service utilization over time (chi2, 10.35; p < or = .0001); and received significantly fewer face-to-face visits from office-based practitioners (chi2, 19.38; p < or = .0001) and other medical diagnostic and laboratory services. They also received significantly less acute care through emergency departments (chi2, 25.88; p < or = .0001) and inpatient facilities (chi2, 23.92; p < or = .0001), but were in the treatment system for longer periods of time despite their higher prevalence of multiple comorbid conditions. The total cost of care for pediatric African American patients was significantly lower (F, 90.84; p < or = .0001) than for non-African Americans. In this primary care system, there were early and persistent disparities in the receipt of outpatient, emergency, and inpatient services over time delivered to African American children and adolescents with multiple medical needs.

Interpersonal processes of care survey: patient-reported measures for diverse groups

OBJECTIVE

To create a patient-reported, multidimensional physician/patient interpersonal processes of care (IPC) instrument appropriate for patients from diverse racial/ethnic groups that allows reliable, valid, and unbiased comparisons across these groups. DATA SOURCE/DATA COLLECTION: Data were collected by telephone interview. The survey was administered in English and Spanish to adult general medicine patients, stratified by race/ethnicity and language (African Americans, English-speaking Latinos, Spanish-speaking Latinos, non-Latino whites) (N=1,664).

STUDY DESIGN/METHODS

In this cross-sectional study, items were designed to be appropriate for diverse ethnic groups based on focus groups, our prior framework, literature, and cognitive interviews. Multitrait scaling and confirmatory factor analysis were used to examine measurement invariance; we identified scales that allowed meaningful quantitative comparisons across four race/ethnic/language groups.

PRINCIPAL FINDINGS

The final instrument assesses several subdomains of communication, patient-centered decision making, and interpersonal style. It includes 29 items representing 12 first-order and seven second-order factors with equivalent meaning (metric invariance) across groups; 18 items (seven factors) allowed unbiased mean comparison across groups (scalar invariance). Final scales exhibited moderate to high reliability.

CONCLUSIONS

The IPC survey can be used to describe disparities in interpersonal care, predict patient outcomes, and examine outcomes of quality improvement efforts to reduce health care disparities.