National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
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Topics
- Access to Care (8)
- Adverse Events (2)
- Behavioral Health (3)
- Brain Injury (1)
- Cancer (3)
- Cancer: Breast Cancer (1)
- Cancer: Colorectal Cancer (2)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (2)
- Care Management (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Clinician-Patient Communication (3)
- Colonoscopy (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Cultural Competence (1)
- Data (2)
- Dental and Oral Health (1)
- Diabetes (2)
- Digestive Disease and Health (1)
- (-) Disparities (51)
- Elderly (8)
- Electronic Health Records (EHRs) (2)
- Emergency Department (1)
- Emergency Medical Services (EMS) (2)
- Guidelines (2)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (1)
- Healthcare Delivery (3)
- Healthcare Utilization (3)
- Health Information Technology (HIT) (1)
- Health Insurance (2)
- Health Status (1)
- Heart Disease and Health (2)
- Hospitalization (3)
- Human Immunodeficiency Virus (HIV) (1)
- Low-Income (1)
- Maternal Care (1)
- Medicaid (3)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (2)
- Medication (3)
- Mortality (3)
- Newborns/Infants (1)
- Nursing (2)
- Obesity (1)
- Obesity: Weight Management (2)
- Outcomes (3)
- Pain (1)
- Palliative Care (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (6)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (2)
- Policy (2)
- Practice Patterns (2)
- Pregnancy (1)
- Prevention (2)
- Quality Improvement (1)
- Quality of Care (3)
- Racial and Ethnic Minorities (24)
- Registries (1)
- Risk (2)
- Rural Health (2)
- Sepsis (1)
- Sex Factors (2)
- Shared Decision Making (3)
- Social Determinants of Health (10)
- Social Stigma (2)
- Stroke (2)
- Substance Abuse (2)
- Surgery (3)
- Telehealth (1)
- Treatments (3)
- Vulnerable Populations (2)
- Web-Based (1)
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
26 to 50 of 51 Research Studies DisplayedBlosnich JR, Hammer J, Yu L
Health care use, health behaviors, and medical conditions among individuals in same-sex and opposite-sex partnerships: a cross-sectional observational analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011.
Thsi study's objective was to examine associations between sexual minority status and medical conditions. The researchers used MEPS data to determine measures of health risk, health services utilization, and the presence of 15 medical conditions. They found that individuals in same-sex partnerships had 67% increased odds of past-year emergency department utilization and 51% greater odds of three or more physician visits in the last year compared with opposite-sex partnered individuals.
AHRQ-funded; HS022989.
Citation: Blosnich JR, Hammer J, Yu L .
Health care use, health behaviors, and medical conditions among individuals in same-sex and opposite-sex partnerships: a cross-sectional observational analysis of the Medical Expenditures Panel Survey (MEPS), 2003-2011.
Med Care 2016 Jun;54(6):547-54. doi: 10.1097/mlr.0000000000000529.
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Keywords: Healthcare Delivery, Disparities, Healthcare Utilization, Medical Expenditure Panel Survey (MEPS)
Chin MH, Lopez FY, Nathan AG
Improving shared decision making with LGBT racial and ethnic minority patients.
In 2014, the authors' team at the University of Chicago, supported by funds from AHRQ and the Patient-Centered Outcomes Research Trust Fund, began examining how to reduce disparities for LGBT racial/ethnic minority patients through improved shared decisionmaking (SDM). Their three goals are to review what is known, to perform interviews and focus groups of patients and clinicians, and to develop tools and resources. The three articles in this issue’s JGIM symposium on "Improving Shared Decision Making with LGBT Racial and Ethnic Minority Patients" reflect their initial foundational work.
AHRQ-funded; HS023050.
Citation: Chin MH, Lopez FY, Nathan AG .
Improving shared decision making with LGBT racial and ethnic minority patients.
J Gen Intern Med 2016 Jun;31(6):591-3. doi: 10.1007/s11606-016-3607-4.
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Keywords: Shared Decision Making, Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Ellis CT, Samuel CA, Stitzenberg KB
National trends in nonoperative management of rectal adenocarcinoma.
The researchers examined the use of non-operative management (NOM) for rectal cancer over time and the patient- and facility-level factors associated with its use. They found evidence of increasing NOM use, with this increase occurring more frequently in black and uninsured/Medicaid patients, raising concern that increased NOM use may actually represent increasing disparities in rectal cancer care rather than innovation. They recommended further studies to assess survival differences by treatment strategy.
AHRQ-funded; HS000032.
Citation: Ellis CT, Samuel CA, Stitzenberg KB .
National trends in nonoperative management of rectal adenocarcinoma.
J Clin Oncol 2016 May 10;34(14):1644-51. doi: 10.1200/jco.2015.64.2066.
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Keywords: Cancer, Cancer: Colorectal Cancer, Disparities, Patient-Centered Healthcare, Treatments
Reid AE, Rosenthal L, Earnshaw VA
Discrimination and excessive weight gain during pregnancy among Black and Latina young women.
The researchers examined the influence of discrimination, a culturally relevant stressor, on odds of gaining weight beyond Institute of Medicine recommendations during pregnancy. They found that ever experiencing discrimination was associated with a 71 percent increase in the odds of excessive weight gain.
AHRQ-funded; HS022986.
Citation: Reid AE, Rosenthal L, Earnshaw VA .
Discrimination and excessive weight gain during pregnancy among Black and Latina young women.
Soc Sci Med 2016 May;156:134-41. doi: 10.1016/j.socscimed.2016.03.012..
Keywords: Disparities, Obesity: Weight Management, Pregnancy, Racial and Ethnic Minorities, Social Stigma
Cook BL, Kim G, Morgan KL
Measuring geographic "hot spots" of racial/ethnic disparities: an application to mental health care.
The researchers identified geographic "hot spots" of racial/ethnic disparities in mental health care access. They identified these "hot spots": Richmond, Virginia, and Columbus, Georgia, for Black-White disparities; Fresno, California, and Dallas, Texas, for Latino-White disparities; and Riverside, California, and Houston, Texas, for Asian-White mental health care disparities. They discussed the potential and limitations of these methods as tools for understanding health care disparities in other contexts.
AHRQ-funded; HS021486.
Citation: Cook BL, Kim G, Morgan KL .
Measuring geographic "hot spots" of racial/ethnic disparities: an application to mental health care.
J Health Care Poor Underserved 2016;27(2):663-84. doi: 10.1353/hpu.2016.0091.
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Keywords: Access to Care, Disparities, Behavioral Health, Racial and Ethnic Minorities
Healy MA, Yin H, Wong SL
Multimodal cancer care in poor prognosis cancers: resection drives long-term outcomes.
The researchers compared effects of resection with other therapies on long-term outcomes across U.S. hospitals. They examined claims in the Surveillance, Epidemiology, and End Results (SEER) Medicare dataset for patients with esophageal and pancreatic cancers and found that a significant association exists between long-term survival and rates of cancer-directed surgery across hospitals, without variation in rates of other therapies.
AHRQ-funded; HS020937.
Citation: Healy MA, Yin H, Wong SL .
Multimodal cancer care in poor prognosis cancers: resection drives long-term outcomes.
J Surg Oncol 2016 May;113(6):599-604. doi: 10.1002/jso.24217.
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Keywords: Cancer, Outcomes, Surgery, Treatments, Disparities
Servan-Mori E, Sosa-Rubi SG, Najera-Leon E
Timeliness, frequency and content of antenatal care: which is most important to reducing indigenous disparities in birth weight in Mexico?
The authors estimated the potential for added weight gain among indigenous infants if their mothers received timely, frequent, and complete antenatal care (ANC). They found that the frequency of ANC was positively associated with birth weight for all women but complete ANC appears to differentially affect indigenous women at the bottom of the birth weight distribution.
AHRQ-funded; HS017582.
Citation: Servan-Mori E, Sosa-Rubi SG, Najera-Leon E .
Timeliness, frequency and content of antenatal care: which is most important to reducing indigenous disparities in birth weight in Mexico?
Health Policy Plan 2016 May;31(4):444-53. doi: 10.1093/heapol/czv082.
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Keywords: Disparities, Maternal Care, Racial and Ethnic Minorities, Newborns/Infants, Obesity: Weight Management
Flottemesch TJ, Raetzman S, Heslin KC
AHRQ Author: Heslin KC
Age-related disparities in trauma center access for severe head injuries following the release of the updated field triage guidelines.
Reflecting perceived undertriage to trauma centers (TCs) for older adults, the American College of Surgeons' Committee on Trauma and the Center for Disease Control revised field triage guidelines in 2011 with additional emphasis on direct transport to a Level I or II trauma center. Researchers examined whether age-based disparities in TC care for severe head injury decreased. Although patterns of increased TC treatment for all groups with severe head trauma indicate improvements, age-based disparities persisted.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Flottemesch TJ, Raetzman S, Heslin KC .
Age-related disparities in trauma center access for severe head injuries following the release of the updated field triage guidelines.
Acad Emerg Med 2016 Apr;24(4):447-57. doi: 10.1111/acem.13150.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Elderly, Brain Injury, Emergency Medical Services (EMS)
Qato DM, Trivedi AN, Mor V
Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert.
The researchers compared time to discontinuation of rosiglitazone after the safety alert between black and white elderly persons, and across sociodemographic and economic subgroups. They found that white race and a history of low personal income modestly predicted later discontinuation of rosiglitazone after the FDA's safety advisory in 2007.
AHRQ-funded; HS019657.
Citation: Qato DM, Trivedi AN, Mor V .
Disparities in discontinuing rosiglitazone following the 2007 FDA safety alert.
Med Care 2016 Apr;54(4):406-13. doi: 10.1097/mlr.0000000000000502..
Keywords: Medication, Disparities, Elderly, Social Determinants of Health, Vulnerable Populations
Nadpara PA, Madhavan SS, Tworek C
Disparities in lung cancer care and outcomes among elderly in a medically underserved state population-a cancer registry-linked database study.
The purpose of this study was to evaluate the patterns of lung cancer care and associated health outcomes among elderly residing in a rural and medically underserved area. The authors found that delays in diagnosis and treatment varied significantly: survival outcomes significantly improved with appropriate care but did not improve with timely care. They concluded that their study highlights the critical need to address disparities in receipt of guideline-concordant lung cancer care among the elderly residing in rural and medically underserved areas.
AHRQ-funded; HS018622.
Citation: Nadpara PA, Madhavan SS, Tworek C .
Disparities in lung cancer care and outcomes among elderly in a medically underserved state population-a cancer registry-linked database study.
Popul Health Manag 2016 Apr;19(2):109-19. doi: 10.1089/pop.2015.0027.
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Keywords: Disparities, Elderly, Cancer: Lung Cancer, Outcomes, Vulnerable Populations
Sheetz KH, Dimick JB, Ghaferi AA
Impact of hospital characteristics on failure to rescue following major surgery.
This study determined the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare beneficiaries. It found that although several hospital characteristics are associated with lower failure to rescue rates, these macrosystem factors explain a small proportion of the variability between hospitals. This suggests that microsystem characteristics may play a larger role in improving a hospital's ability to manage postoperative complications.
AHRQ-funded; HS023621.
Citation: Sheetz KH, Dimick JB, Ghaferi AA .
Impact of hospital characteristics on failure to rescue following major surgery.
Ann Surg 2016 Apr;263(4):692-7. doi: 10.1097/sla.0000000000001414.
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Keywords: Surgery, Elderly, Adverse Events, Disparities, Mortality
Wernli KJ, Brenner AT, Rutter CM
Risks associated with anesthesia services during colonoscopy.
The researchers aimed to quantify the difference in complications from colonoscopy with vs without anesthesia services. They concluded that the overall risk of complications after colonoscopy increases when individuals receive anesthesia services. The widespread adoption of anesthesia services with colonoscopy should be considered within the context of all potential risks.
AHRQ-funded; HS013853; HS019482.
Citation: Wernli KJ, Brenner AT, Rutter CM .
Risks associated with anesthesia services during colonoscopy.
Gastroenterology 2016 Apr;150(4):888-94. doi: 10.1053/j.gastro.2015.12.018.
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Keywords: Adverse Events, Care Management, Colonoscopy, Disparities, Patient Safety, Risk
Lee S, Teschemaker AR, Daniel M
Calcium and vitamin D use among older adults in U.S.: results from national survey.
The investigators conducted this study to describe a 10-year trend of calcium and vitamin D use from 2000 to 2009 and to evaluate age, gender, and racial disparities using national level health data. They found variability in the access to the medications, despite the observed increases associated with calcium and vitamin D supplements.
AHRQ-funded; HS011673.
Citation: Lee S, Teschemaker AR, Daniel M .
Calcium and vitamin D use among older adults in U.S.: results from national survey.
J Nutr Health Aging 2016 Mar;20(3):300-5. doi: 10.1007/s12603-015-0614-9.
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Keywords: Disparities, Racial and Ethnic Minorities, Sex Factors
Kessler DO, Walsh B, Whitfill T
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
The authors sought to measure and compare adherence to pediatric sepsis guidelines across a spectrum of emergency departments. They found that among 47 teams across 24 emergency departments, adherent teams had significantly higher Emergency Medical Services for Children readiness scores, MD composition of physicians to total team members, teamwork scores, provider perceptions of pediatric preparedness, and provider perceptions of sepsis preparedness. They concluded that only composite team experience level of the providers was associated with improved guideline adherence.
AHRQ-funded; HS020286.
Citation: Kessler DO, Walsh B, Whitfill T .
Disparities in adherence to pediatric sepsis guidelines across a spectrum of emergency departments: a multicenter, cross-sectional observational in situ simulation study.
J Emerg Med 2016 Mar;50(3):403-15.e1-3. doi: 10.1016/j.jemermed.2015.08.004.
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Keywords: Emergency Department, Disparities, Guidelines, Children/Adolescents, Sepsis
Li J, Maxwell AE, Glenn BA
Healthcare access and utilization among Korean Americans: The mediating role of English use and proficiency.
This study examines whether English language use and proficiency plays a mediating role in the relationships between length of hospital stay in the US and health insurance coverage, access to, and use of care. Results show that health care utilization was primarily driven by having health insurance and a usual source of care. Recommendations include a focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans to mitigate health disparities associated with reduced access to health services in this population.
AHRQ-funded; HS000046.
Citation: Li J, Maxwell AE, Glenn BA .
Healthcare access and utilization among Korean Americans: The mediating role of English use and proficiency.
Int J Soc Sci Res 2016 Mar;4(1):83-97. doi: 10.5296/ijssr.v4i1.8678.
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Keywords: Access to Care, Cultural Competence, Disparities, Healthcare Utilization, Racial and Ethnic Minorities
Lyerly MJ, Wu TC, Mullen MT
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
The authors sought to determine the effect of telemedicine on access to acute stroke care for racial and ethnic minorities in the state of Texas. They found that telemedicine increased access to acute stroke care for 1.5 million Texans, and they found no evidence of disparities in access to the acute stroke expertise afforded by telemedicine.
AHRQ-funded; HS013852.
Citation: Lyerly MJ, Wu TC, Mullen MT .
The effects of telemedicine on racial and ethnic disparities in access to acute stroke care.
J Telemed Telecare 2016 Mar;22(2):114-20. doi: 10.1177/1357633x15589534.
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Keywords: Access to Care, Disparities, Racial and Ethnic Minorities, Stroke, Telehealth
Chen J, Vargas-Bustamante A, Mortensen K
Racial and ethnic disparities in health care access and utilization under the Affordable Care Act.
The objective of this study was to examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014. Its results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health insurance.
AHRQ-funded; HS022135.
Citation: Chen J, Vargas-Bustamante A, Mortensen K .
Racial and ethnic disparities in health care access and utilization under the Affordable Care Act.
Med Care 2016 Feb;54(2):140-6. doi: 10.1097/mlr.0000000000000467.
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Keywords: Access to Care, Disparities, Healthcare Utilization, Health Insurance
Chen J, Mullins CD, Novak P
Personalized strategies to activate and empower patients in health care and reduce health disparities.
The authors proposed a patient-centered, multilevel activation and empowerment framework 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. They 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.
AHRQ-funded; HS022135.
Citation: Chen J, Mullins CD, Novak P .
Personalized strategies to activate and empower patients in health care and reduce health disparities.
Health Educ Behav 2016 Feb;43(1):25-34. doi: 10.1177/1090198115579415.
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Keywords: Shared Decision Making, Disparities, Patient and Family Engagement, Patient-Centered Healthcare, Racial and Ethnic Minorities
Ricciardi R, Moy E, Wilson NJ
AHRQ Author: Ricciardi R and Moy E
Finding the true north: lessons from the National Healthcare Quality and Disparities Report.
The authors delineate important features and findings of the 2014 report. For example, it shows that one measure of patient safety improved quickly. The rate of central line–associated bloodstream infection per 1000 medical and surgical discharges (age 18+ years or obstetric admissions) improved at an annual rate of change of more than 10 percent. This success reflects the direct impact that nurses can have in making care safer for their patients.
AHRQ authors Ricciardi and Moy
Citation: Ricciardi R, Moy E, Wilson NJ .
Finding the true north: lessons from the National Healthcare Quality and Disparities Report.
J Nurs Care Qual 2016 Jan-Mar;31(1):9-12. doi: 10.1097/ncq.0000000000000164..
Keywords: Quality of Care, Disparities, Patient Safety, Nursing, Central Line-Associated Bloodstream Infections (CLABSI)
Roberts MC, Weinberger M, Dusetzina SB
Racial variation in the uptake of oncotype DX testing for early-stage breast cancer.
Oncotype DX (ODX) has the potential to improve quality of care; however, if not equally accessible across racial groups, disparities in cancer care quality may persist or worsen. The researchers examined racial disparities in ODX testing uptake. They did not find racial disparities in ODX testing for node-negative patients for whom ODX testing is guideline recommended and widely covered by insurers.
HS019468; HS022189
Citation: Roberts MC, Weinberger M, Dusetzina SB .
Racial variation in the uptake of oncotype DX testing for early-stage breast cancer.
J Clin Oncol 2016 Jan 10;34(2):130-8. doi: 10.1200/jco.2015.63.2489..
Keywords: Cancer: Breast Cancer, Healthcare Delivery, Treatments, Disparities, Racial and Ethnic Minorities
Albright KC, Boehme AK, Tanner RM
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
The authors examined racial differences in risk factors being addressed among stroke survivors and those at risk for stroke. They found that addressed hypertension and hyperlipidemia in stroke-naïve participants were significantly lower in blacks than in whites. They concluded that a better understanding of this information is critical to preventing stroke and other vascular diseases.
AHRQ-funded; HS023009; HS013852.
Citation: Albright KC, Boehme AK, Tanner RM .
Addressing stroke risk factors in black and white Americans: Findings from the National Health and Nutrition Examination Survey, 2009-2010.
Ethn Dis 2016 Jan 21;26(1):9-16. doi: 10.18865/ed.26.1.9.
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Keywords: Disparities, Racial and Ethnic Minorities, Patient-Centered Outcomes Research, Prevention, Stroke
Mayer LA, Elliott MN, Haas A
Less use of extreme response options by asians to standardized care scenarios may explain some racial/ethnic differences in CAHPS scores.
The researchers explored whether lower extreme response tendency ( ERT) is observed for Asians than whites in response to standardized vignettes depicting patient experiences of care and whether ERT might in part explain Asians reporting worse care than whites. They concluded that lower ERT in Asians may partially explain observations of lower observed mean CAHPS scores for Asians in real-world settings.
AHRQ-funded; HS016980.
Citation: Mayer LA, Elliott MN, Haas A .
Less use of extreme response options by asians to standardized care scenarios may explain some racial/ethnic differences in CAHPS scores.
Med Care 2016 Jan;54(1):38-44. doi: 10.1097/mlr.0000000000000453..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Disparities, Racial and Ethnic Minorities, Patient Experience, Patient Experience
Wallaert JB, Nolan BW, Stone DH
Physician specialty and variation in carotid revascularization technique selected for Medicare patients.
The researchers investigated whether the choice of carotid artery stenting (CAS) vs. carotid endarterectomy (CEA) varies as a function of treating physician specialty, which would result in regional variation in the relative use of these treatment types They found that the proportion of all carotid revascularization procedures performed as CAS varies markedly by geographic region, and regions with the highest proportion of cardiologists perform the most CAS procedures.
AHRQ-funded; HS021581.
Citation: Wallaert JB, Nolan BW, Stone DH .
Physician specialty and variation in carotid revascularization technique selected for Medicare patients.
J Vasc Surg 2016 Jan;63(1):89-97. doi: 10.1016/j.jvs.2015.08.068.
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Keywords: Heart Disease and Health, Medicare, Cardiovascular Conditions, Disparities, Outcomes
Toledo P, Eosakul ST, Grobman WA
Primary spoken language and neuraxial labor analgesia use among Hispanic Medicaid recipients.
The researchers investigated whether there is a disparity in anticipated or actual use of neuraxial labor analgesia among Hispanic women based on primary language (English versus Spanish). A language-based disparity was found in neuraxial labor analgesia use. It is possible that there are communication barriers in knowledge or understanding of analgesic options.
AHRQ-funded; HS020122.
Citation: Toledo P, Eosakul ST, Grobman WA .
Primary spoken language and neuraxial labor analgesia use among Hispanic Medicaid recipients.
Anesth Analg 2016 Jan;122(1):204-9. doi: 10.1213/ane.0000000000001079.
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Keywords: Racial and Ethnic Minorities, Disparities, Clinician-Patient Communication, Pain, Medicaid
Bakken S, Reame N
The promise and potential perils of big data for advancing symptom management research in populations at risk for health disparities.
The purposes of this chapter are to (a) briefly summarize the current drivers for the use of big data in research; (b) describe the promise of big data and associated data science methods for advancing symptom management research; and (c) explicate the potential perils of big data and data science from the perspective of the ethical principles of autonomy, beneficence, and justice.
AHRQ-funded; HS022961.
Citation: Bakken S, Reame N .
The promise and potential perils of big data for advancing symptom management research in populations at risk for health disparities.
Annu Rev Nurs Res 2016;34:247-60. doi: 10.1891/0739-6686.34.247..
Keywords: Disparities, Data, Patient-Centered Outcomes Research, Registries