1
|
Chen J, Spencer MRT, Buchongo P, Wang MQ. Hospital-based Health Information Technology Infrastructure: Evidence of Reduced Medicare Payments and Racial Disparities Among Patients With ADRD. Med Care 2023; 61:27-35. [PMID: 36349964 PMCID: PMC9741995 DOI: 10.1097/mlr.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Alzheimer disease and related dementia (ADRD) is one of the most expensive health conditions in the United States. Understanding the potential cost-savings or cost-enhancements of Health Information Technology (HIT) can help policymakers understand the capacity of HIT investment to promote population health and health equity for patients with ADRD. OBJECTIVES This study examined access to hospital-based HIT infrastructure and its association with racial and ethnic disparities in Medicare payments for patients with ADRD. RESEARCH DESIGN We used the 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Association Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries who were diagnosed with ADRD. Our study focused on hospital-based telehealth-postdischarge (eg, remote patient monitoring) and telehealth-treatment (eg, psychiatric and addiction treatment) services. RESULTS Results showed that hospital-based telehealth postdischarge services were associated with significantly higher total Medicare payment and acute inpatient Medicare payment per person per year among patients with ADRD on average. The associations between hospital-based telehealth-treatment services and payments were not significant. However, the association varied by patient's race and ethnicity. The reductions of the payments associated with telehealth postdischarge and treatment services were more pronounced among Black patients with ADRD. Telehealth-treatment services were associated with significant payment reductions among Hispanic patients with ADRD. CONCLUSION Results showed that having hospital-based telehealth services might be cost-enhancing at the population level but cost-saving for Black and Hispanic patients with ADRD. Results suggested that personalized HIT services might be necessary to reduce the cost associated with ADRD treatment for racial and ethnic minority groups.
Collapse
Affiliation(s)
- Jie Chen
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Merianne Rose T. Spencer
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Portia Buchongo
- Department of Health Policy and Management
- The Hospital And Public health interdisciPlinarY research (HAPPY) Lab
| | - Min Qi Wang
- Department of Health Policy and Management
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD
| |
Collapse
|
2
|
Albaroudi A, Chen J. Consumer Assessment of Healthcare Providers and Systems Among Racial and Ethnic Minority Patients With Alzheimer Disease and Related Dementias. JAMA Netw Open 2022; 5:e2233436. [PMID: 36166229 PMCID: PMC9516284 DOI: 10.1001/jamanetworkopen.2022.33436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures have been used widely to measure patient-centered care. Evidence is needed to understand CAHPS measures among racial and ethnic minority patients with Alzheimer disease and related dementias (ADRD). OBJECTIVE To examine racial and ethnic disparities in CAHPS among patients with ADRD and to examine the association between social determinants of health and CAHPS disparities. DESIGN, SETTING, AND PARTICIPANTS This study focused on patients with ADRD who were enrolled in Medicare Shared Savings Program Accountable Care Organizations (ACOs). The primary data sets were the 2017 Medicare Beneficiary Summary File and the beneficiary-level ACO data. The study population was limited to community-based beneficiaries who had a diagnosis of ADRD and were aged 65 years and older. Cross-sectional analyses and the decomposition approach were implemented. Data were analyzed from November 2021 to July 2022. EXPOSURE Enrollment in a Medicare Shared Savings Program ACO. MAIN OUTCOMES AND MEASURES Six ACO CAHPS measures were included: getting timely care, appointments, and information; how well providers communicate; patients' rating of provider; access to specialists; health promotion and education; and shared decision-making. ACO CAHPS were continuous measures with possible ranges from 0 to 100. The summation of these 6 measures as an overall index was also created. In CAHPS measures, the term provider can include hospitals, home health care agencies, and doctors, among others. RESULTS The final sample included 568 368 beneficiaries (347 783 female patients [61.2%]; 38 030 African American patients [6.69%], 6258 Asian patients [1.10%], 18 231 Hispanic patients [3.21%], and 505 849 White patients [89.0%]; mean [SD] age, 82.17 [7.95] years). Significant racial and ethnic disparities in CAHPS scores were observed. After controlling for beneficiary, hospital, and area characteristics, compared with their White counterparts, African American or Black (coefficient = -1.05; 95% CI, -1.15 to -0.95; P < .001), Asian (coefficient = -0.414; 95% CI, -0.623 to -0.205; P < .001), and Hispanic (coefficient = -0.099; 95% CI, -0.229 to 0.032; P = .14) patients with ADRD reported lower total CAHPS scores. Disparities were also observed among individual ACO CAHPS. Decomposition results showed that a proxy for social determinants of health explained 10% to 13% of disparities of ACO CAHPS between African American or Black vs White and Hispanic vs White patients with ADRD. Most of the racial and ethnic disparities, especially those between White and Asian individuals, could not be explained by the models used to analyze data. CONCLUSIONS AND RELEVANCE These results demonstrated significant variations in CAHPS by race and ethnicity among patients with ADRD enrolled in ACOs. Social determinants of health are critical in explaining racial and ethnic disparities. More research is needed to explain disparities in CAHPS.
Collapse
Affiliation(s)
- Asmaa Albaroudi
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
- The Hospital And Public Health Interdisciplinary Research Lab, School of Public Health, University of Maryland, College Park
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park
- The Hospital And Public Health Interdisciplinary Research Lab, School of Public Health, University of Maryland, College Park
| |
Collapse
|
3
|
Albright K, de Jesus Diaz Perez M, Trujillo T, Beascochea Y, Sammen J. Addressing health care needs of Colorado immigrants using a community power building approach. Health Serv Res 2022; 57 Suppl 1:111-121. [PMID: 35243625 DOI: 10.1111/1475-6773.13933] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess and address through policy change the health-care needs of immigrant populations in Colorado. DATA SOURCES Primary data were collected in two Colorado communities from June 2019 through December 2020. STUDY DESIGN This work utilized a mixed-method, community power building approach to determine and meet health-care needs of immigrants, a marginalized population of mixed documentation status. Findings were then used to inform Emergency Medicaid (EM) expansion in Colorado. DATA COLLECTION In-depth interviews were conducted in Spanish, English, and Somali with 47 immigrants in rural Morgan County in June-September 2019; findings were presented to the community for feedback in January-February 2020. In March-December 2020, 330 interviews were conducted in Spanish and English with 208 unique individuals in Morgan and Pueblo Counties by local community grassroots leaders via four rounds of a novel phone tree outreach method. Interviewees were identified through snowball sampling and direct outreach among individuals seeking immediate relief (i.e., food assistance). PRINCIPAL FINDINGS Interviewees reported numerous barriers to health-care access, including discrimination and limited service hours and transportation options. Data also revealed a clear health insurance coverage gap among undocumented immigrants. These data were then presented to Colorado's Department of Health-Care Policy and Financing, ultimately contributing to securing EM expansion to this population to include COVID treatment, including respiratory therapies and outpatient follow-up appointments. Data-informed continued implementation advocacy to ensure the effectiveness of EM program expansion. CONCLUSIONS Immigrants are particularly marginalized by the health-care system. Rapid data collection grounded in a community power-building approach produced data that directly informed state policy and an increased power base. This approach enables direct connection to immediate "downstream" needs in communities while simultaneously building collective systemic "upstream" analysis and capacity of community members and laying pathways to translation and implementation of research into policy.
Collapse
Affiliation(s)
- Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Veterans Affairs, Denver-Seattle Center of Innovation (COIN), Aurora, Colorado, USA
| | - Maria de Jesus Diaz Perez
- Research and Performance Measurement, Center for Improving Value in Health Care, Denver, Colorado, USA
| | | | | | - Joe Sammen
- Center for Health Progress, Denver, Colorado, USA
| |
Collapse
|
4
|
Bustamante AV, Chen J, Félix Beltrán L, Ortega AN. Health Policy Challenges Posed By Shifting Demographics And Health Trends Among Immigrants To The United States. Health Aff (Millwood) 2021; 40:1028-1037. [PMID: 34228519 DOI: 10.1377/hlthaff.2021.00037] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Since the 1960s the immigrant population in the United States has increased fourfold, reaching 44.7 million, or 13.7 percent of the US population, in 2018. The shifting immigrant demography presents several challenges for US health policy makers. We examine recent trends in immigrant health and health care after the Great Recession and the nationwide implementation of the Affordable Care Act. Recent immigrants are more likely to have lower incidence of chronic health conditions than other groups in the US, although these differences vary along the citizenship and documentation status continuum. Health care inequities among immigrants and US-born residents increased after the Great Recession and later diminished after the Affordable Care Act took effect. Unremitting inequities remain, however, particularly among noncitizen immigrants. The number of aging immigrants is growing, which will present a challenge to the expansion of coverage to this population. Health care and immigration policy changes are needed to integrate immigrants successfully into the US health care system.
Collapse
Affiliation(s)
- Arturo Vargas Bustamante
- Arturo Vargas Bustamante is a professor in the Department of Health Policy and Management at the UCLA Fielding School of Public Health, and faculty director of research at the UCLA Latino Policy and Politics Initiative, University of California Los Angeles, in Los Angeles, California
| | - Jie Chen
- Jie Chen is a professor in the Department of Health Policy and Management, School of Public Health, University of Maryland, in College Park, Maryland
| | - Lucía Félix Beltrán
- Lucía Félix Beltrán is a research assistant in the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Alexander N Ortega
- Alexander N. Ortega is a professor in the Department of Health Management and Policy, Drexel University Dornsife School of Public Health, in Philadelphia, Pennsylvania
| |
Collapse
|
5
|
Levison JH, Levinson JK, Alegría M. A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care. AIDS Behav 2018; 22:2500-2512. [PMID: 29948334 DOI: 10.1007/s10461-018-2187-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.
Collapse
|
6
|
Jones AL, Cochran SD, Leibowitz A, Wells KB, Kominski G, Mays VM. Racial, Ethnic, and Nativity Differences in Mental Health Visits to Primary Care and Specialty Mental Health Providers: Analysis of the Medical Expenditures Panel Survey, 2010-2015. Healthcare (Basel) 2018; 6:healthcare6020029. [PMID: 29565323 PMCID: PMC6023347 DOI: 10.3390/healthcare6020029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/10/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022] Open
Abstract
Background. Black and Latino minorities have traditionally had poorer access to primary care than non-Latino Whites, but these patterns could change with the Affordable Care Act (ACA). To guide post-ACA efforts to address mental health service disparities, we used a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. Methods. Data were obtained from the Medical Expenditures Panel Survey (MEPS), a two-year panel study of healthcare use, satisfaction with care, and costs of services in the United States (US). We pooled data from six waves (14–19) of participants with serious psychological distress to examine racial, ethnic, and nativity disparities in medical and mental health visits to primary care (PC) and specialty mental health (SMH) providers around the time of ACA reforms, 2010–2015. Results. Of the 2747 respondents with serious psychological distress, 1316 were non-Latino White, 632 non-Latino Black, 532 identified as Latino with Mexican, Central American, or South American (MCS) origins, and 267 as Latino with Caribbean island origins; 525 were foreign/island born. All racial/ethnic groups were less likely than non-Latino Whites to have any PC visit. Of those who used PC, non-Latino Blacks were less likely than Whites to have a PC mental health visit, while foreign born MCS Latinos were less likely to visit an SMH provider. Conditional on any mental health visit, Latinos from the Caribbean were more likely than non-Latino Whites to visit SMH providers versus PC providers only, while non-Latino Blacks and US born MCS Latinos received fewer PC mental health visits than non-Latino Whites. Conclusion. Racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
Collapse
Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | - Susan D Cochran
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles (UCLA), CA 90095, USA.
- Department of Statistics, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
| | - Arleen Leibowitz
- UCLA Luskin School of Public Affairs, Los Angeles, CA 90095, USA.
| | - Kenneth B Wells
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA.
- UCLA Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
| | - Gerald Kominski
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- UCLA Center for Health Policy Research, Los Angeles, CA 90024, USA.
| | - Vickie M Mays
- UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles, CA 90095, USA.
- Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA 90095, USA.
| |
Collapse
|
7
|
Drewniak D, Krones T, Wild V. Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review. Int J Nurs Stud 2017; 70:89-98. [PMID: 28236689 DOI: 10.1016/j.ijnurstu.2017.02.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/21/2016] [Accepted: 02/10/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Recent investigations of ethnicity related disparities in health care have focused on the contribution of providers' implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical research on the potential influence of health care professionals' attitudes and behaviors towards ethnic minority patients on health care disparities. DESIGN Integrative literature review. DATA SOURCES Four internet-based literature indexes - MedLine, PsychInfo, Sociological Abstracts and Web of Science - were searched for articles published between 1982 and 2012 discussing health care professionals' attitudes or behaviors towards ethnic minority patients. REVIEW METHODS Thematic analysis was used to synthesize the relevant findings. RESULTS We found 47 studies from 12 countries. Six potential barriers to health care for ethnic minorities were identified that may be related to health care professionals' attitudes or behaviors: Biases, stereotypes and prejudices; Language and communication barriers; Cultural misunderstandings; Gate-keeping; Statistical discrimination; Specific challenges of delivering care to undocumented migrants. CONCLUSIONS Data on health care professionals' attitudes or behaviors are both limited and inconsistent. We thus provide reflections on methods, conceptualization, interpretation and the importance of the geographical or socio-political settings of potential studies. More empirical data is needed, especially on health care professionals' attitudes or behaviors towards (irregular) migrant patients.
Collapse
Affiliation(s)
- Daniel Drewniak
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland.
| | - Tanja Krones
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland; Clinical Ethics, University Hospital Zurich, c/o Dermatologische Klinik, Gloriastrasse 31, 8091 Zurich, Switzerland.
| | - Verina Wild
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland; Chair of Philosophy IV, Ludwig-Maximilians-University of Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany.
| |
Collapse
|
8
|
Rubin D, Coles VB, Barnett JT. Linguistic Stereotyping in Older Adults' Perceptions of Health Care Aides. HEALTH COMMUNICATION 2016; 31:911-916. [PMID: 26606170 DOI: 10.1080/10410236.2015.1007549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The cultural and linguistic diversity of the U.S. health care provider workforce is expanding. Diversity among health care personnel such as paraprofessional health care assistants (HCAs)-many of whom are immigrants-means that intimate, high-stakes cross-cultural and cross-linguistic contact characterizes many health interactions. In particular, nonmainstream HCAs may face negative patient expectations because of patients' language stereotypes. In other contexts, reverse linguistic stereotyping has been shown to result in negative speaker evaluations and even reduced listening comprehension quite independently of the actual language performance of the speaker. The present study extends the language and attitude paradigm to older adults' perceptions of HCAs. Listeners heard the identical speaker of Standard American English as they watched interactions between an HCA and an older patient. Ethnolinguistic identities-either an Anglo native speaker of English or a Mexican nonnative speaker-were ascribed to HCAs by means of fabricated personnel files. Dependent variables included measures of perceived HCA language proficiency, personal characteristics, and professional competence, as well as listeners' comprehension of a health message delivered by the putative HCA. For most of these outcomes, moderate effect sizes were found such that the HCA with an ascribed Anglo identity-relative to the Mexican guise-was judged more proficient in English, socially superior, interpersonally more attractive, more dynamic, and a more satisfactory home health aide. No difference in listening comprehension emerged, but the Anglo guise tended to engender a more compliant listening mind set. Results of this study can inform both provider-directed and patient-directed efforts to improve health care services for members of all linguistic and cultural groups.
Collapse
Affiliation(s)
- Donald Rubin
- a Department of Communication Studies and the Center for Health & Risk Communication University of Georgia
| | | | - Joshua Trey Barnett
- c Department of Communication and the Center for Global Change and Sustainability University of Utah
| |
Collapse
|
9
|
The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland. Soc Sci Med 2016; 161:64-73. [PMID: 27258017 DOI: 10.1016/j.socscimed.2016.05.039] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/24/2016] [Accepted: 05/25/2016] [Indexed: 11/23/2022]
Abstract
This study examines the influence of patients' immigration background and residence permit status on physicians' willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians' time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.
Collapse
|
10
|
Chen J, Mullins CD, Novak P, Thomas SB. Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities. HEALTH EDUCATION & BEHAVIOR 2016; 43:25-34. [PMID: 25845376 PMCID: PMC4681678 DOI: 10.1177/1090198115579415] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and self-determination for their own health and health care. We propose a patient-centered, multilevel activation and empowerment framework (individual-, health care professional-, community-, and health care delivery system-level) to inform the development of culturally informed personalized patient activation and empowerment (P-PAE) interventions to improve population health and reduce racial and ethnic disparities. We discuss relevant Affordable Care Act payment and delivery policy reforms and how they affect patient activation and empowerment. Such policies include Accountable Care Organizations and value-based purchasing, patient-centered medical homes, and the community health benefit. Challenges and possible solutions to implementing the P-PAE are discussed. Comprehensive and longitudinal data sets with consistent P-PAE measures are needed to conduct comparative effectiveness analyses to evaluate the optimal P-PAE model. We believe the P-PAE model is timely and sustainable and will be critical to engaging patients in their treatment, developing patients' abilities to manage their health, helping patients express concerns and preferences regarding treatment, empowering patients to ask questions about treatment options, and building up strategic patient-provider partnerships through shared decision making.
Collapse
Affiliation(s)
- Jie Chen
- University of Maryland, Baltimore, MD, USA
| | | | | | | |
Collapse
|
11
|
Tilert TJ, Chen J. Smoking-cessation advice to patients with chronic obstructive pulmonary disease: the critical roles of health insurance and source of care. Am J Prev Med 2015; 48:683-93. [PMID: 25998920 DOI: 10.1016/j.amepre.2014.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Smoking cessation is the most effective therapeutic intervention for chronic obstructive pulmonary disease (COPD) patients. However, the proportion of smokers with COPD who have received physician advice to quit smoking is unknown. The purpose of this study is to assess the prevalence of receipt of smoking-cessation advice among adults with COPD and explore factors predicting advice receipt. METHODS This study employed nationally representative data from the Medical Expenditure Panel Survey (MEPS), collected in 2008-2011 on adults aged ≥20 years. Logistic regression models were conducted to estimate the likelihood of receiving provider advice. Data were analyzed in 2014. RESULTS Four percent (95% CI=3.8%, 4.2%) of adults reported being diagnosed with COPD. Among them, 38.5% (95% CI=36.1%, 40.8%) were current smokers. Among those who had seen a physician in the past year, 85.6% (95% CI=83.1%, 88.0%) were advised to quit smoking. Logistic regression revealed negative associations between receipt of smoking-cessation advice and having fewer healthcare visits (AOR=0.41, 95% CI=0.23, 0.72); being uninsured (AOR=0.43, 95% CI=0.22, 0.83); having no usual source of care (AOR=0.39, 95% CI=0.19, 0.80); and having no comorbid chronic diseases (AOR=0.50, 95% CI=0.29, 0.85). CONCLUSIONS Having no usual source of care and no health insurance are major barriers to receiving smoking-cessation advice among patients with COPD. The Patient Protection and Affordable Care Act has the potential to increase advice receipt in this high-risk population by expanding health insurance coverage and increasing the number of people with a usual source of care.
Collapse
Affiliation(s)
- Timothy J Tilert
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland.
| | - Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland
| |
Collapse
|
12
|
Ortega AN, Rodriguez HP, Vargas Bustamante A. Policy dilemmas in Latino health care and implementation of the Affordable Care Act. Annu Rev Public Health 2015; 36:525-44. [PMID: 25581154 DOI: 10.1146/annurev-publhealth-031914-122421] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The changing Latino demographic in the United States presents a number of challenges to health care policy makers, clinicians, organizations, and other stakeholders. Studies have demonstrated that Latinos tend to have worse patterns of access to, and utilization of, health care than other ethnic and racial groups. The implementation of the Affordable Care Act (ACA) of 2010 may ameliorate some of these disparities. However, even with the ACA, it is expected that Latinos will continue to have problems accessing and using high-quality health care, especially in states that are not expanding Medicaid eligibility as provided by the ACA. We identify four current policy dilemmas relevant to Latinos' health and ACA implementation: (a) the need to extend coverage to the undocumented; (b) the growth of Latino populations in states with limited insurance expansion;
Collapse
Affiliation(s)
- Alexander N Ortega
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772; ,
| | | | | |
Collapse
|
13
|
Qian F, Eaton MP, Lustik SJ, Hohmann SF, Diachun CB, Pasternak R, Wissler RN, Glance LG. Racial disparities in the use of blood transfusion in major surgery. BMC Health Serv Res 2014; 14:121. [PMID: 24618049 PMCID: PMC3995741 DOI: 10.1186/1472-6963-14-121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 03/04/2014] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Racial disparities in healthcare in the United States are widespread and have been well documented. However, it is unknown whether racial disparities exist in the use of blood transfusion for patients undergoing major surgery. METHODS We used the University HealthSystem Consortium database (2009-2011) to examine racial disparities in perioperative red blood cells (RBCs) transfusion in patients undergoing coronary artery bypass surgery (CABG), total hip replacement (THR), and colectomy. We estimated multivariable logistic regressions to examine whether black patients are more likely than white patients to receive perioperative RBC transfusion, and to investigate potential sources of racial disparities. RESULTS After adjusting for patient-level factors, black patients were more likely to receive RBC transfusions for CABG (AOR = 1.41, 95% CI: [1.13, 1.76], p = 0.002) and THR (AOR = 1.39, 95% CI: [1.20, 1.62], p < 0.001), but not for colectomy (AOR = 1.08, 95% CI: [0.90, 1.30], p = 0.40). Black-white disparities in blood transfusion persisted after controlling for patient insurance and hospital effects (CABG: AOR = 1.42, 95% CI: [1.30, 1.56], p < 0.001; THR: AOR = 1.43, 95% CI: [1.29, 1.58], p < 0.001). CONCLUSIONS We detected racial disparities in the use of blood transfusion for CABG and THR (black patients tended to receive more transfusions compared with whites), but not for colectomy. Reporting racial disparities in contemporary transfusion practices may help reduce potentially unnecessary blood transfusions in minority patients.
Collapse
Affiliation(s)
- Feng Qian
- Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, One University Place, GEC 169, 12144-3445 Rensselaer, NY, USA
| | - Michael P Eaton
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Stewart J Lustik
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Samuel F Hohmann
- Principal Consultant, Comparative Data & Information Research, University HealthSystem Consortium, Chicago, IL, USA
- Department of Health Systems Management, Rush University, Chicago, IL, USA
| | - Carol B Diachun
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Robert Pasternak
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Richard N Wissler
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| | - Laurent G Glance
- Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA
| |
Collapse
|
14
|
Griggs JJ, Liu Y, Sorbero ME, Jagielski CH, Maly RC. Adjuvant chemotherapy dosing in low-income women: the impact of Hispanic ethnicity and patient self-efficacy. Breast Cancer Res Treat 2014; 144:665-72. [PMID: 24596046 DOI: 10.1007/s10549-014-2869-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 02/06/2014] [Indexed: 12/30/2022]
Abstract
Unwarranted breast cancer adjuvant chemotherapy dose reductions have been documented in black women, women of lower socioeconomic status, and those who are obese. No information on the quality of chemotherapy is available in Hispanic women. The purpose of this study was to characterize factors associated with first cycle chemotherapy dose selection in a multi-ethnic sample of low-income women receiving chemotherapy through the Breast and Cervical Cancer Prevention Treatment Program (BCCPT) and to investigate the impact of Hispanic ethnicity and patient self-efficacy on adjuvant chemotherapy dose selection. Survey and chemotherapy information were obtained from consenting participants enrolled in the California BCCPT. Analyses identified clinical and non-clinical factors associated with first cycle chemotherapy doses less than 90 % of expected doses. Of 552 patients who received chemotherapy, 397 (72 %) were eligible for inclusion. First cycle dose reductions were given to 14 % of the sample. In multivariate analyses, increasing body mass index and non-academic treatment site were associated with doses below 90 % of the expected doses. No other clinical or non-clinical factors, including ethnicity, were associated with first cycle doses selection. In this universally low-income sample, we identified no association between Hispanic ethnicity and other non-clinical patient factors, including patient self-efficacy, in chemotherapy dose selection. As seen in other studies, obesity was associated with systematic dose limits. The guidelines on chemotherapy dose selection in the obese may help address such dose reductions. A greater understanding of the association between type of treatment site and dose selection is warranted. Overall, access to adequate health care allows the vast majority of low-income women with breast cancer to receive high-quality breast cancer chemotherapy.
Collapse
Affiliation(s)
- Jennifer J Griggs
- University of Michigan Ann Arbor, Michigan 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA,
| | | | | | | | | |
Collapse
|
15
|
Kaplan SH, Billimek J, Sorkin DH, Ngo-Metzger Q, Greenfield S. Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project. J Gen Intern Med 2013; 28:1340-9. [PMID: 23645452 PMCID: PMC3785664 DOI: 10.1007/s11606-013-2452-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite numerous efforts to change healthcare delivery, the profile of disparities in diabetes care and outcomes has not changed substantially over the past decade. OBJECTIVE To understand potential contributors to disparities in diabetes care and glycemic control. DESIGN Cross sectional analysis. SETTING Seven outpatient clinics affiliated with an academic medical center. PATIENTS Adult patients with type 2 diabetes who were Mexican American, Vietnamese American or non-Hispanic white (n = 1,484). MEASUREMENTS Glycemic control was measured as hemoglobin A1c (HbA1c) level. Patient, provider and system characteristics included demographic characteristics; access to care; quality of process of care including clinical inertia; quality of interpersonal care; illness burden; mastery (diabetes management confidence, passivity); and adherence to treatment. RESULTS Unadjusted HbA1c values were significantly higher for Mexican American patients (n = 782) (mean = 8.3 % [SD:2.1]) compared with non-Hispanic whites (n = 389) (mean = 7.1 % [SD:1.4]). There were no significant differences in HbA1c values between Vietnamese American and non-Hispanic white patients. There were no statistically significant group differences in glycemic control after adjustment for multiple measures of access, and quality of process and interpersonal care. Disease management mastery and adherence to treatment were related to glycemic control for all patients, independent of race/ethnicity. LIMITATIONS Generalizability to other minorities or to patients with poorer access to care may be limited. CONCLUSIONS The complex interplay among patient, physician and system characteristics contributed to disparities in HbA1c between Mexican American and non-Hispanic white patients. In contrast, Vietnamese American patients achieved HbA1c levels comparable to non-Hispanic whites and adjustment for numerous characteristics failed to identify confounders that could have masked disparities in this subgroup. Disease management mastery appeared to be an important contributor to glycemic control for all patient subgroups.
Collapse
Affiliation(s)
- Sherrie H Kaplan
- Health Policy Research Institute and Department of Medicine, School of Medicine, University of California, Irvine, 100 Theory Suite 110, Irvine, CA, 92697, USA,
| | | | | | | | | |
Collapse
|
16
|
Yennurajalingam S, Parsons HA, Duarte ER, Palma A, Bunge S, Palmer JL, Delgado-Guay MO, Allo J, Bruera E. Decisional control preferences of Hispanic patients with advanced cancer from the United States and Latin America. J Pain Symptom Manage 2013; 46:376-85. [PMID: 23182756 DOI: 10.1016/j.jpainsymman.2012.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 08/20/2012] [Accepted: 08/29/2012] [Indexed: 02/03/2023]
Abstract
CONTEXT Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S. OBJECTIVES The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs). METHODS We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs. RESULTS A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P<0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91). CONCLUSION HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.
Collapse
Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Chen J, Vargas-Bustamante A. Treatment compliance under physician-industry relationship: a framework of health-care coordination in the USA. Int J Qual Health Care 2013; 25:340-7. [PMID: 23407823 DOI: 10.1093/intqhc/mzt017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Factors associated with treatment compliance have been well studied. However, no study has examined treatment compliance under the context of physician-industry relationship. This study developed a conceptual framework of physician-industry relationship and treatment compliance, and empirically tested patients' treatment compliance and affordability under the physician-industry relationship in the USA. DESIGN We first proposed a conceptual framework to analyze different scenarios, where the physician-industry relationship could impact patients' treatment compliance and affordability, taking into consideration the role of health insurers. We then employed a nationally representative data set to investigate these relationships. Multivariable logistic regressions were employed to examine the physician-industry relationship and the physicians' perception of patients' treatment compliance. SETTING AND PARTICIPANTS 2008 Health Tracking Physician Survey. RESULTS Our results showed that physicians with closer industry relationships were more likely to report rejection of care by insurers [odds ratios (ORs): 1.24-1.85, P < 0.001], patients' non-compliance with treatment (OR: 1.34, P < 0.01) and patients' inability to pay (OR: 1.42, P < 0.01) as the major problems affecting their ability to provide high quality care, when compared with physicians without industry relationships. CONCLUSIONS Our results shed light on the lack of articulation among industry, physicians and health insurers in the USA. It is important to make sure that different agents in the health-care marketplace, such as physicians, industry, and health insurers, coordinate more efficiently to provide quality and consistent care to patients.
Collapse
Affiliation(s)
- Jie Chen
- Department of Health Services Administration, School of Public Health, University of Maryland, College Park, 3310A SPH Building, College Park, MD 20742, USA.
| | | |
Collapse
|