National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 753 Research Studies DisplayedBratches RWR, Onsando W, Puga F
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
This study’s objective was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. The authors conducted a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Likert-style questions were used to determine the level of caregiver comfort using computers, smartphones, and tablets. There was a total of 340 caregivers included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.1) of expressing comfort using computers; black caregivers (OR 0.46) and Hispanic caregivers (OR 0.36) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64) of expressing comfort using tablets.
AHRQ-funded; HS013852.
Citation: Bratches RWR, Onsando W, Puga F .
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
Telemed J E Health 2024 Mar; 30(3):685-91. doi: 10.1089/tmj.2023.0314..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Racial and Ethnic Minorities
Parikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Sleath B, Beznos B, Carpenter DM
African American patient-provider communication about glaucoma vision quality-of-life.
A study was conducted to examine African American patient-provider communication about glaucoma-related quality-of-life. Patients completed a vision quality-of-life assessment to examine patient-provider characteristics, patient demographics, and socio-demographics. The study determined that patients with worse literacy, more severe glaucoma, or depression are likely to have a lower vision quality-of-life.
AHRQ-funded; HS025370.
Citation: Sleath B, Beznos B, Carpenter DM .
African American patient-provider communication about glaucoma vision quality-of-life.
Eye 2024 Feb; 38(2):343-48. doi: 10.1038/s41433-023-02693-8..
Keywords: Eye Disease and Health, Racial and Ethnic Minorities, Clinician-Patient Communication, Communication, Quality of Life
Beznos B, Sayner R, Carpenter DM
Do African American patients with glaucoma ask their eye providers the questions they have?
The objective of this randomized controlled trial was to test the effectiveness of a pre-visit video/glaucoma question prompt-list to increase question-asking during medical visits. Participants were adult African American patients with glaucoma and a history of non-adherence to glaucoma medications, The questions that patients checked on the question prompt list were described, and how often the same checked questions were asked during medical visits noted. The findings indicated that although patients with glaucoma had questions about glaucoma and their medications, few asked all their questions during visits. The researchers concluded that future research should focus on ways to improve question asking using a question prompt list.
AHRQ-funded; HS025370.
Citation: Beznos B, Sayner R, Carpenter DM .
Do African American patients with glaucoma ask their eye providers the questions they have?
Eye 2024 Feb; 38(2):279-83. doi: 10.1038/s41433-023-02674-x..
Keywords: Racial and Ethnic Minorities, Eye Disease and Health, Clinician-Patient Communication, Communication
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Jindal M, Barnert E, Chomilo N
AHRQ Author: Mistry KB
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
This partly AHRQ-authored paper is part of a series on Racism and Child Health in the USA, which builds on Paper 1's summary of existing disparities in health-care delivery and highlights policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improves the health of racially and ethnically minoritized children. The authors discuss current and historical policy approaches across housing, employment, health insurance, immigration, and criminal which have the potential to affect child health equity. They commented that these policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. If these policy efforts do not directly address structural racism, they will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism.
AHRQ-authored.
Citation: Jindal M, Barnert E, Chomilo N .
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
Lancet Child Adolesc Health 2024 Feb; 8(2):159-74. doi: 10.1016/s2352-4642(23)00262-6..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Policy
Engelberg RS, Scheidell JD, Islam N
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
This study’s objective was to assess racial/ethnic group differences in the association between incarceration and hypertension and hyperglycemia. The authors performed a secondary data analysis using the National Longitudinal Survey of Adolescent to Adult Health (Add Health). They used Poisson regression to estimate the associations between lifetime history of incarceration reported during early adulthood with hypertension and hyperglycemia outcomes measured in mid-adulthood, including incident diagnosis. They evaluated whether associations varied by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Asian) with an analytic sample of 4,015 Add Health respondents. Outcome measures included hypertension, systolic blood pressure >130 mmHG, and hyperglycemia. There was no evidence of an association between incarceration and measured health outcomes among non-Hispanic Black and non-Hispanic White participants. Among Hispanic participants, incarceration was associated with hyperglycemia (Adjusted Risk Ratio (ARR): 2.1), but not with hypertension risk. Incarceration was associated with elevated systolic blood pressure (ARR: 3.1) and hypertension (ARR: 1.7) among Asian participants, but not with hyperglycemia risk. Incarceration was associated with incident hypertension (ARR 2.5) among Asian subgroups.
AHRQ-funded; HS026120.
Citation: Engelberg RS, Scheidell JD, Islam N .
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
J Gen Intern Med 2024 Jan; 39(1):5-12. doi: 10.1007/s11606-023-08327-9..
Keywords: Vulnerable Populations, Racial and Ethnic Minorities, Blood Pressure, Cardiovascular Conditions, Risk
Eliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Wurcel AG, Guardado R, Grussing ED
Racial differences in testing for infectious diseases: an analysis of jail intake data.
This analysis examines HIV and hepatitis C virus (HCV) testing in Middlesex House of Corrections (MHOC) in Massachusetts. Only 38% of incarcerated individuals who requested testing received it. Black non-Hispanic and Hispanic individuals were more likely to request and complete testing compared to white individuals. These disparities may reflect broader issues of access to care. The study highlights the need for improved testing completion rates and interdisciplinary collaboration in jails.
AHRQ-funded; HS026008.
Citation: Wurcel AG, Guardado R, Grussing ED .
Racial differences in testing for infectious diseases: an analysis of jail intake data.
PLoS One 2023 Dec 20; 18(12):e0288254. doi: 10.1371/journal.pone.0288254.
Keywords: Hepatitis, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities, Vulnerable Populations
Chin MH, Afsar-Manesh N, Bierman AS
AHRQ Author: Bierman AS, Chang C, Jain A, Umscheid C
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
A panel of experts was convened by AHRQ and the National Institute for Minority Health and Health Disparities to provide a conceptual framework and guiding principles for preventing bias in health care algorithms to promote health care equity. Multiple stakeholders can mitigate bias at each phase of the algorithm life cycle. Five principles should guide these efforts: promoting health and health care equity during all phases of the algorithm life cycle; ensuring algorithm use is transparent and explainable; engaging patients and communities during all phases of the algorithm life cycle to earn trustworthiness; identifying algorithmic fairness issues and establishing accountability for equity and fairness in outcomes from health care algorithms.
AHRQ-authored; AHRQ-funded.
Citation: Chin MH, Afsar-Manesh N, Bierman AS .
Guiding principles to address the impact of algorithm bias on racial and ethnic disparities in health and health care.
JAMA Netw Open 2023 Dec; 6(12):e2345050. doi: 10.1001/jamanetworkopen.2023.45050..
Keywords: Racial and Ethnic Minorities, Disparities
Efird CR, Barrington c, Metzl JM
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
This study’s purpose was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. The authors conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. They found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. White rural residents tended to have condemning discourses that illustrated their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. On the other hand, Black residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors for White residents differ from Black residents with White residents primarily concerned about perceived social changes and Black residents referencing experiences of interpersonal and structure racism. Both Black and White residents found social support from involvement in their respective religious organizations as help for coping, but only Black residents signified that a personal relationship with a higher ower was an essential positive coping mechanism.
AHRQ-funded; HS000032.
Citation: Efird CR, Barrington c, Metzl JM .
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
Soc Sci Med 2023 Nov; 336:116245. doi: 10.1016/j.socscimed.2023.116245..
Keywords: Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents, Behavioral Health
Stevens ER, Caverly T, Butler JM
Considerations for using predictive models that include race as an input variable: the case study of lung cancer screening.
Indiscriminate use of predictive models incorporating race can reinforce biases present in source data and lead to an exacerbation of health disparities. In some countries, such as the United States, there is therefore a push to remove race from prediction models; however, there are still many prediction models that use race as an input. Biomedical informaticists who are given the responsibility of using these predictive models in healthcare environments are likely to be faced with questions like how to deal with race covariates in these models. The authors report that there is a need for a practical framework to facilitate model user thinking on how to incorporate race in their chosen model to avoid inadvertently amplifying disparities. The purpose of this paper is to utilize a case study of lung cancer screening to propose a simple framework to guide model users in approaching race inputs in the predictive models they are attempting to leverage in electronic health records and clinical workflows.
AHRQ-funded; HS028791.
Citation: Stevens ER, Caverly T, Butler JM .
Considerations for using predictive models that include race as an input variable: the case study of lung cancer screening.
J Biomed Inform 2023 Nov; 147:104525. doi: 10.1016/j.jbi.2023.104525..
Keywords: Cancer: Lung Cancer, Cancer, Racial and Ethnic Minorities
Salinas KE, Bazan M, Rivera L
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
The purpose of this study was to explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers. The researchers conducted focus groups with patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center. A total of seven focus groups with 27 total participants were held. The study identified three key themes regarding preferences in patient experiences and communication when seeking pregnancy care: 1. language discordance and concordance between patients and clinicians exist on a spectrum and are not binary; 2. language-discordant care presents communication challenges, even when interpreters are present; and 3. language discordance can be effectively addressed with positive interpersonal engagements between clinicians and patients.
AHRQ-funded; HS026370.
Citation: Salinas KE, Bazan M, Rivera L .
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
Obstet Gynecol 2023 Nov 1; 142(5):1227-36. doi: 10.1097/aog.0000000000005369..
Keywords: Maternal Care, Women, Communication, Cultural Competence, Racial and Ethnic Minorities
Kerlikowske K, Bissell MCS, Sprague BL
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Researchers evaluated differences in body mass index (BMI) in relation to differences in dense breasts prevalence by race/ethnicity. Their results indicated that dense breasts were most prevalent among Asian women followed by non-Hispanic White, Hispanic, and Black women. Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI. IMPACT: If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Bissell MCS, Sprague BL .
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Cancer Epidemiol Biomarkers Prev 2023 Nov; 32(11):1524-30. doi: 10.1158/1055-9965.Epi-23-0049..
Keywords: Obesity, Women, Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Imaging
Heintzman J, Springer R, Marino M
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Researchers examined the association between adolescent-mother language concordance and neighborhood social deprivation with adolescent vaccination completion in order to understand social/family factors related to Latino adolescent vaccination. They used a multistate, EHR-based dataset of community health center patients to compare three Latino groups; their sample included over 56,000 adolescent-mother dyads. Their findings indicated that English-preferring adolescents with Spanish-preferring mothers had the highest completion rates. The researchers concluded that future studies could attempt to understand what advantage this language dyad may have in adolescent vaccination completion.
AHRQ-funded; HS025962.
Citation: Heintzman J, Springer R, Marino M .
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Matern Child Health J 2023 Nov; 27(11):2026-37. doi: 10.1007/s10995-023-03742-0..
Keywords: Racial and Ethnic Minorities, Community-Based Practice, Vaccination, Children/Adolescents, Vulnerable Populations, Social Determinants of Health
Plummer N, Guardado R, Ngassa Y
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
This cross-sectional study evaluated the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. The authors used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction, located in Billerica, MA. They evaluated two primary outcomes: (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake over half (57%) in the sample self-reported a history of mental illness, with 20% reporting the use of psychiatric medications. Among people who self-reported a history of mental illness, non-White inmates all had decreased odds of reporting psychiatric medication. Only 20% reported receiving medications in the community prior to incarceration.
AHRQ-funded; HS026008.
Citation: Plummer N, Guardado R, Ngassa Y .
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
Adm Policy Ment Health 2023 Nov; 50(6):966-75. doi: 10.1007/s10488-023-01297-4..
Keywords: Racial and Ethnic Minorities, Behavioral Health, Vulnerable Populations
Reed KG, Sun Z, Yabes JG
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
The purpose of this study was to evaluate variations among patients who do and do not visit Commission on Cancer (CoC) accredited facilities. The researchers utilized Pennsylvania Cancer Registry data linked to facility records for 87,472 patients diagnosed with cancer between 2018 and 2019. The study found that patients in the most advantaged Area Deprivation Index quartiles were more likely to visit CoC facilities compared with other quartiles. Urban patients were more likely than rural to be seen at a CoC facility as were Hispanic patients and non-Hispanic Black patients compared with White patients.
AHRQ-funded; HS027396.
Citation: Reed KG, Sun Z, Yabes JG .
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
JNCI Cancer Spectr 2023 Oct 31; 7(6). doi: 10.1093/jncics/pkad080..
Keywords: Cancer, Health Information Technology (HIT), Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Fernandez JR, Strassle PD, Richmond J
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S., if they were associated with willingness to receive the COVID-19 vaccine, and if they differed across racial/ethnic groups. Data was taken from the REACH-US study. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Results showed that American Indian/Alaska Native, African American, Hispanic/Latino, and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine. History of low vaccination was associated with less willingness to receive the COVID-19 vaccine among African American adults. The researchers concluded that future vaccination programs should include efforts accounting for structural barriers to preventive healthcare and their intersection with sociodemographic factors.
AHRQ-funded; HS026122.
Citation: Fernandez JR, Strassle PD, Richmond J .
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
Front Public Health 2023 Oct 12; 11:1192748. doi: 10.3389/fpubh.2023.1192748..
Keywords: COVID-19, Vaccination, Patient Adherence/Compliance, Racial and Ethnic Minorities
Bonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Bourgeois FC, Hart NJ, Dong Z
Partnering with patients and families to improve diagnostic safety through the OurDX tool: effects of race, ethnicity, and language preference.
This study’s objective was to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage pediatric patients and their families in the diagnostic process (DxP). This cross-sectional study included 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, which was codeveloped and tested with patients and families. Patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns prior to each visit. The authors conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70) or "other" race (OR: 1.48) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53). No significant differences were found in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference.
AHRQ-funded; HS027367.
Citation: Bourgeois FC, Hart NJ, Dong Z .
Partnering with patients and families to improve diagnostic safety through the OurDX tool: effects of race, ethnicity, and language preference.
Appl Clin Inform 2023 Oct; 14(5):903-12. doi: 10.1055/s-0043-1776055..
Keywords: Diagnostic Safety and Quality, Patient Safety, Racial and Ethnic Minorities
Hernandez-Boussard T, Siddique SM, Bierman AS
AHRQ Author: Bierman AS
Promoting equity in clinical decision making: dismantling race-based medicine.
The authors recommended a race-aware approach to clinical decision support to address concerns raised about racial and ethnic biases built into the algorithms that lead to persistent disparities in health and healthcare. The proposed approach will require sustained commitment and effort among stakeholders, research, and technology sectors. Important steps will include increasing diversity in clinical trial populations, broadening the focus of precision medicine, improving education about complex factors that shape health outcomes, and developing new guidelines and policies that enable culturally responsive care.
AHRQ-authored.
Citation: Hernandez-Boussard T, Siddique SM, Bierman AS .
Promoting equity in clinical decision making: dismantling race-based medicine.
Health Affairs 2023 Oct; 42(10):1369-73. doi: 10.1377/hlthaff.2023.00545..
Keywords: Racial and Ethnic Minorities, Clinical Decision Support (CDS), Health Information Technology (HIT)
Rubio K, Fraze TK, Bibi S
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
The purpose of this study was to explore whether primary care practices serving high rates of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower rates of these same populations. 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions participated in the study. The study found that 26.9% of the eligible practices were CPC+ participants. In statistically adjusted analyses, primary care practices with high shares of Black and Latino beneficiaries had a lower likelihood of participating in CPC+ compared to practices with lower shares of these beneficiary groups. Participation disparities for practices with relatively high shares of Black beneficiaries partially explained state differences in CPC+ participation rates but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries.
AHRQ-funded; HS024075.
Citation: Rubio K, Fraze TK, Bibi S .
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
J Gen Intern Med 2023 Oct; 38(13):2945-52. Epub ahead of print. doi: 10.1007/s11606-023-08160-0..
Keywords: Racial and Ethnic Minorities, Primary Care, Medicare
Ramirez M, Duran MC, Penfold RB
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
This paper describes what is needed to adapt the STAR-Caregivers Virtual Training and Follow-up (STAR-VTF), an evidence-based intervention that teaches family caregivers how to manage behavioral and psychological symptoms of dementia to Latino caregivers. This qualitative research study interviewed Spanish- and English-speaking caregivers of people with dementia who self-identify as Hispanic/Latino (N = 30) and healthcare and social service providers of older Latino clients and/or Latino family caregivers (N = 14). The authors identified three themes: (i) there was a need to increase awareness about dementia and decrease stigma; (ii) semantics mattered as certain words and phrases could be stigmatizing, offensive, or culturally inappropriate; and (iii) there was a need to incorporate into program materials the traditional family structure and nature of caregiving in Latino families. Based on findings, STAR-VTF was adapted to expand content to improve understanding of dementia, language was revised that was viewed as problematic, and cultural examples were added to reflect the range of family involvement in caring for people living with dementia and multigenerational living.
AHRQ-funded; HS026369.
Citation: Ramirez M, Duran MC, Penfold RB .
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
Transl Behav Med 2023 Sep 12; 13(9):625-34. doi: 10.1093/tbm/ibad028..
Keywords: Education: Patient and Caregiver, Cultural Competence, Racial and Ethnic Minorities, Dementia, Neurological Disorders
Laytner LA, Olmeda K, Salinas J
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
The purpose of this study was to explore the effects of acculturation and subjective norms on Hispanic individuals' intentions to use antibiotics without a prescription from the following sources: 1) United States markets (not legal), 2) other countries, 3) leftovers from previous prescriptions, and 4) friends/relatives. The study found that of the 263 patients surveyed, 47% reported previous non-prescription use, and 54% expressed intention to use non-prescription antibiotics if feeling sick. Individuals with lower acculturation (Spanish-speaking preferences) expressed greater intentions to utilize antibiotics from abroad and from any source. Individuals with more friends/relatives who obtain antibiotics abroad were over 2.5 times more likely to intend to utilize non-prescription antibiotics from friends/relatives. Other predictors of intention to utilize non-prescription antibiotics included high costs of doctor visits and perceived language barriers in the clinic.
AHRQ-funded; HS026901.
Citation: Laytner LA, Olmeda K, Salinas J .
Acculturation and subjective norms impact non-prescription antibiotic use among Hispanic patients in the United States.
Antibiotics 2023 Sep 8; 12(9). doi: 10.3390/antibiotics12091419..
Keywords: Racial and Ethnic Minorities, Antibiotics, Medication, Antimicrobial Stewardship