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Cevallos P, Amakiri UO, Johnstone T, Kim TSE, Maheta B, Nazerali R, Sheckter C. Is Plastic Surgery Training Equitable? An Analysis of Health Equity across US Plastic Surgery Residency Programs. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4900. [PMID: 37035124 PMCID: PMC10079348 DOI: 10.1097/gox.0000000000004900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
Achieving health equity includes training surgeons in environments exemplifying access, treatment, and outcomes across the racial, ethnic, and socioeconomic spectrum. Increased attention on health equity has generated metrics comparing hospitals. To establish the quality of health equity in plastic and reconstructive surgery (PRS) residency training, we determined the mean equity score (MES) across training hospitals of US PRS residencies. Methods The 2021 Lown Institute Hospital Index database was merged with affiliated training hospitals of US integrated PRS residency programs. The Lown equity category is composed of three domains (community benefit, inclusivity, pay equity) generating a health equity grade. MES (standard deviation) was calculated and reported for residency programs (higher MES represented greater health equity). Linear regression modeled the effects of a program's number of training hospitals, safety net hospitals, and geographical region on MES. Results The MES was 2.64 (0.62). An estimated 5.9% of programs had an MES between 1-2. In total, 56.5% of programs had an MES between 2 and 3, and 37.7% had an MES of 3 or more. The southern region was associated with a higher MES compared with the reference group (Northeast) (P = 0.03). The number of safety net hospitals per program was associated with higher MES (P = 0.02). Conclusions Two out of three programs train residents in facilities failing to demonstrate high equity healthcare. Programs should promote health equity by diversifying care delivery through affiliated hospitals. This will aid in the creation of a PRS workforce trained to provide care for a socioeconomically, racially, and ethnically diverse population.
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Affiliation(s)
- Priscila Cevallos
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
- Geisel School of Medicine, Dartmouth University, Hanover, N.H
| | | | - Thomas Johnstone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Trudy Sea-Eun Kim
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Bhagvat Maheta
- College of Medicine, California Northstate University, Elk Grove, Calif
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
| | - Clifford Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, Calif
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Butterfield JT, Golzarian S, Johnson R, Fellows E, Dhawan S, Chen CC, Marcotte EL, Venteicher AS. Racial disparities in recommendations for surgical resection of primary brain tumours: a registry-based cohort analysis. Lancet 2022; 400:2063-2073. [PMID: 36502844 DOI: 10.1016/s0140-6736(22)00839-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/12/2022] [Accepted: 04/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. METHODS In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. FINDINGS This study included US national data from the SEER (1975-2016) and NCDB (2004-17) databases of adults with a new diagnosis of meningioma (SEER n=63 674; NCDB n=222 673), glioblastoma (n=35 258; n=104 047), pituitary adenoma (n=27 506; n=87 772), vestibular schwannoma (n=11 525; n=30 745), astrocytoma (n=5402; n=10 631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural-urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06-1·21, p<0·0001), glioblastoma (1·14, 1·01-1·28, p=0·038), pituitary adenoma (1·13, 1·05-1·22, p<0·0001), and vestibular schwannoma (1·48, 1·19-1·84, p<0·0001) when compared with White patients in the SEER dataset. Additionally, patients of unknown race had significantly higher odds of recommendation against surgical resection for pituitary adenoma (1·80, 1·41-2·30, p<0·0001) and vestibular schwannoma (1·49, 1·10-2·04, p=0·011). Performing a validation analysis using the NCDB dataset confirmed these significant results for Black patients with meningioma (1·18, 1·14-1·22, p<0·0001), glioblastoma (1·19, 1·12-1·28, p<0·0001), pituitary adenoma (1·21, 1·16-1·25, p<0·0001), and vestibular schwannoma (1·19, 1·04-1·35, p=0·0085), and indicated and indicated that the findings are independent of patient comorbidities. When further restricted to the most recent decade in SEER, these inequities held true for Black patients, except those with glioblastoma (meningioma [1·18, 1·08-1·28, p<0·0001], pituitary adenoma [1·20, 1·09-1·31, p<0·0001], and vestibular schwannoma [1·54, 1·16-2·04, p=0·0031]). INTERPRETATION Racial disparities in surgery recommendations in the USA exist for patients with primary brain tumours, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care. FUNDING None.
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Affiliation(s)
- John T Butterfield
- Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Sina Golzarian
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Reid Johnson
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Emily Fellows
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Erin L Marcotte
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Andrew S Venteicher
- Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA.
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Shostak S, Bandini J, Cadge W, Donahue V, Lewis M, Grone K, Trachtenberg S, Kacmarek R, Lux L, Matthews C, McAuley ME, Romain F, Snydeman C, Tehan T, Robinson E. Encountering the social determinants of health on a COVID-19 ICU: Frontline providers' perspectives on inequality in a time of pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:100001. [PMID: 34870264 PMCID: PMC8459572 DOI: 10.1016/j.ssmqr.2021.100001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
Abstract
Efforts to improve health equity may be advanced by understanding health care providers' perceptions of the causes of health inequalities. Drawing on data from in-depth interviews with nurses and registered respiratory therapists (RRTs) who served on intensive care units (ICUs) during the first surge of the pandemic, this paper examines how frontline providers perceive and attribute the unequal impacts of COVID-19. It shows that nurses and RRTs quickly perceived the pandemic's disproportionate burden on Black and Latinx individuals and families. Providers attribute these inequalities to the social determinants of health, and also raise questions about how barriers to healthcare access may have made some patients more vulnerable to the worst consequences of COVID-19. Providers' perceptions of inequality and its consequences on COVID-19 ICUs were emotionally impactful and distressing, suggesting that this is a critical moment for offering clinicians practical strategies for understanding and addressing the persistent structural inequities that cause racial inequalities in health.
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Affiliation(s)
- Sara Shostak
- Brandeis University, Department of Sociology, MS 071, 415 South Street, Waltham, MA, 02453, USA
| | - Julia Bandini
- RAND Corporation, 20 Park Plaza, Boston, MA, 02116, USA
| | - Wendy Cadge
- Brandeis University, Department of Sociology, MS 071, 415 South Street, Waltham, MA, 02453, USA
| | - Vivian Donahue
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Mariah Lewis
- Brandeis University, Department of Sociology, MS 071, 415 South Street, Waltham, MA, 02453, USA
| | - Katelyn Grone
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Sophie Trachtenberg
- Brandeis University, Department of Sociology, MS 071, 415 South Street, Waltham, MA, 02453, USA
| | - Robert Kacmarek
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Laura Lux
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Cristina Matthews
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | | | - Frederic Romain
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Colleen Snydeman
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Tara Tehan
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Ellen Robinson
- The Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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Dancis J, Coleman BR. Transformative dissonant encounters: Opportunities for cultivating antiracism in White nursing students. Nurs Inq 2021; 29:e12447. [PMID: 34350660 DOI: 10.1111/nin.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/27/2022]
Abstract
Sharply in focus in the United States right now is the disproportionate COVID-19 infection, hospitalization, and mortality rates of Black, Indigenous, Hispanic, and Pacific Islanders living in the United States in contrast to White people. These COVID-19 disparities are but one example of how systemic racism filters into health outcomes for many Black, Indigenous, and other People of Color (BIPOC). With these issues front and center, more attention is being given to the ways that White medical professionals contribute to these disparities, including their socialization to ignore or deny inequities. As such, the present study sought to understand how educating White health-care pre-professionals about systemic racism might influence their understanding of and responsibility for disrupting White supremacy. Data were drawn from 49 White-identified nursing students who participated in a mapping project that uncovered instantiations of systemic racism in the United States. Participant written reflections were analyzed using thematic analysis. Findings revealed that mapping projects can develop White people's knowledge and understanding of systemic racism. We introduce the construct, transformative dissonant encounters, to describe how this project precipitated shifts in world view necessary for White people to confront systemic racism. Implications for nursing educators, psychological researchers, and antiracist activists are discussed.
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Affiliation(s)
- Julia Dancis
- Applied Psychology, Portland State University, Portland, Oregon, USA
| | - Brett Russell Coleman
- Health and Community Studies, Western Washington University, Bellingham, Washington, USA
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Eliacin J, Cunningham B, Partin MR, Gravely A, Taylor BC, Gordon HS, Saha S, Burgess DJ. Veterans Affairs Providers' Beliefs About the Contributors to and Responsibility for Reducing Racial and Ethnic Health Care Disparities. Health Equity 2019; 3:436-448. [PMID: 31448354 PMCID: PMC6707034 DOI: 10.1089/heq.2019.0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.
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Affiliation(s)
- Johanne Eliacin
- Center for Health information and Communication, CHIC, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
- Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
- Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
- ACT Center of Indiana, Indianapolis, Indiana
| | - Brooke Cunningham
- Department of Family Medicine and Community Health, Minneapolis, Minnesota
| | - Melissa R. Partin
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
| | - Brent C. Taylor
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Howard S. Gordon
- Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, Illinois
- Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, Illinois
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
| | - Diana J. Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
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6
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Rosenbloom JM, Jackson J, Alegria M, Alvarez K. Healthcare provider perceptions of disparities in perioperative care. J Natl Med Assoc 2019; 111:616-624. [PMID: 31431287 DOI: 10.1016/j.jnma.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Many strategies to alleviate racial/ethnic disparities in surgical care target healthcare providers. Yet limited data exists about the perception of disparities among the range of clinical staff who work in perioperative settings. Such information could help initiate conversations about disparities in perioperative care and, if necessary, implement interventions to alleviate them. Our aim was to evaluate the association between sociodemographic characteristics, clinical position (physicians and non-physicians) and perception of perioperative disparities at a large tertiary care center. METHODS We surveyed perioperative staff at the institution using an anonymous online survey. Primary outcome was respondents' perception of disparities in perioperative care at the institution due to patients' insurance status/type, ability to speak English, education, and racial/ethnic minority status. The association between clinical position (physician vs. non-physician) and perception of disparities was assessed in bivariate and then multivariable analysis, adjusting for respondents' race, sex, age, and years at the institution. Secondary outcomes included perception of disparities in perioperative care in the United States due to patients' insurance status/type, ability to speak English, education, and racial/ethnic minority status. RESULTS 217 completed questions that could be analyzed. Among these responders, 101 were physicians (46.5%), 165 (76.0%) were white, and 144 (66.4.%) were female. Bivariate and multivariate analysis revealed that physicians had higher perception of disparities in perioperative care at the institution based on patients' ability to speak English, education, and racial/ethnic minority status. Physicians also had higher perceptions of disparities in perioperative care in the United States than non-physicians. CONCLUSIONS Physicians reported higher perceptions of disparities in perioperative care than non-physicians, potentially explained by differences in training or contact with patients. Such findings serve as a first step at examining and discussing disparities in perioperative care and warrant further study.
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Affiliation(s)
- Julia M Rosenbloom
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02115, USA.
| | - Jaleesa Jackson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02115, USA
| | - Margarita Alegria
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St. Suite 830, Boston, MA 02114, USA; Departments of Medicine and Psychiatry, Harvard Medical School, Boston, MA 02114, USA
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St. Suite 830, Boston, MA 02114, USA
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Gollust SE, Cunningham BA, Bokhour BG, Gordon HS, Pope C, Saha SS, Jones DM, Do T, Burgess DJ. What Causes Racial Health Care Disparities? A Mixed-Methods Study Reveals Variability in How Health Care Providers Perceive Causal Attributions. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 55:46958018762840. [PMID: 29553296 PMCID: PMC5862368 DOI: 10.1177/0046958018762840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Progress to address health care equity requires health care providers’ commitment, but their engagement may depend on their perceptions of the factors contributing to inequity. To understand providers’ perceptions of causes of racial health care disparities, a short survey was delivered to health care providers who work at 3 Veterans Health Administration sites, followed by qualitative interviews (N = 53). Survey data indicated that providers attributed the causes of disparities to social and economic conditions more than to patients’ or providers’ behaviors. Qualitative analysis revealed differences in the meaning that participants ascribed to these causal factors. Participants who believed providers contribute to disparities discussed race and racism more readily, identified the mechanisms through which disparities emerge, and contextualized patient-level factors more than those who believed providers contributed less to disparities. Differences in provider understanding of the underlying causal factors suggest a multidimensional approach to engage providers in health equity efforts.
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Affiliation(s)
| | | | - Barbara G Bokhour
- 2 Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, Bedford, MA, USA.,3 Boston University, MA, USA
| | - Howard S Gordon
- 4 Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA.,5 University of Illinois at Chicago, USA
| | - Charlene Pope
- 6 Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,7 Medical University of South Carolina, Charleston, USA
| | - Somnath S Saha
- 8 VA Portland Health Care System, OR, USA.,9 Oregon Health & Science University, Portland, USA
| | | | - Tam Do
- 11 Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, MN, USA
| | - Diana J Burgess
- 1 University of Minnesota, Minneapolis, USA.,11 Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, MN, USA
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8
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Burgess DJ, Bokhour BG, Cunningham BA, Do T, Eliacin J, Gordon HS, Gravely A, Jones DM, Partin MR, Pope C, Saha S, Taylor BC, Gollust SE. Communicating with providers about racial healthcare disparities: The role of providers' prior beliefs on their receptivity to different narrative frames. PATIENT EDUCATION AND COUNSELING 2019; 102:139-147. [PMID: 30266266 DOI: 10.1016/j.pec.2018.08.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 08/20/2018] [Accepted: 08/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Evaluate narratives aimed at motivating providers with different pre-existing beliefs to address racial healthcare disparities. METHODS Survey experiment with 280 providers. Providers were classified as high or low in attributing disparities to providers (HPA versus LPA) and were randomly assigned to a non-narrative control or 1 of 2 narratives: "Provider Success" (provider successfully resolved problem involving Black patient) and "Provider Bias" (Black patient experienced racial bias, which remained unresolved). Participants' reactions to narratives (including identification with narrative) and likelihood of participating in disparities-reduction activities were immediately assessed. Four weeks later, participation in those activities was assessed, including self-reported participation in a disparities-reduction training course (primary outcome). RESULTS Participation in training was higher among providers randomized to the Provider Success narrative compared to Provider Bias or Control. LPA participants had higher identification with Provider Success than Provider Bias narratives, whereas among HPA participants, differences in identification between the narratives were not significant. CONCLUSIONS Provider Success narratives led to greater participation in training than Provider Bias narratives, although providers' pre-existing beliefs influenced the narrative they identified with. PRACTICE IMPLICATIONS Provider Success narratives may be more effective at motivating providers to address disparities than Provider Bias narratives, though more research is needed.
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Affiliation(s)
- Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, ENRM Veterans Affairs Medical Center, MA, USA; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | | | - Tam Do
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA
| | - Johanne Eliacin
- Center for Health information and Communication, CHIC, Health Services Research & Development, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA; Department of Psychology, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, USA; Health Services Research, Regenstrief Institute, Inc., Indianapolis, IN, USA; ACT Center of Indiana, Indianapolis, IN, USA
| | - Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center and Center of Innovation for Complex Chronic Healthcare, Chicago, IL, USA; Section of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Amy Gravely
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Dina M Jones
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Charlene Pope
- Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA; Division General Pediatrics, Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, SC, USA; College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Somnath Saha
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA; Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, OR, USA
| | - Brent C Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Metzl JM, Petty J, Olowojoba OV. Using a structural competency framework to teach structural racism in pre-health education. Soc Sci Med 2017; 199:189-201. [PMID: 28689630 DOI: 10.1016/j.socscimed.2017.06.029] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022]
Abstract
The inclusion of structural competency training in pre-health undergraduate programs may offer significant benefits to future healthcare professionals. This paper presents the results of a comparative study of an interdisciplinary pre-health curriculum based in structural competency with a traditional premedical curriculum. The authors describe the interdisciplinary pre-health curriculum, titled Medicine, Health, and Society (MHS) at Vanderbilt University. The authors then use a new survey tool, the Structural Foundations of Health Survey, to evaluate structural skills and sensibilities. The analysis compares MHS majors (n = 185) with premed science majors (n = 63) and first-semester freshmen (n = 91), with particular attention to understanding how structural factors shape health. Research was conducted from August 2015 to December 2016. Results suggest that MHS majors identified and analyzed relationships between structural factors and health outcomes at higher rates and in deeper ways than did premed science majors and freshmen, and also demonstrated higher understanding of structural and implicit racism and health disparities. The skills that MHS students exhibited represent proficiencies increasingly stressed by the MCAT, the AAMC, and other educational bodies that emphasize how contextual factors shape expressions of health and illness.
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Affiliation(s)
- Jonathan M Metzl
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN, United States.
| | - JuLeigh Petty
- Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN, United States
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10
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Keating G, Jaine R. What supports are needed by New Zealand primary care to improve equity and quality? J Prim Health Care 2016. [PMID: 29530155 DOI: 10.1071/hc16020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
While some primary care practices have found ways to deliver quality care more equitably to their Māori and Pacific patients, others have struggled to get started or be successful. Quality Symposium attendees shared their views on barriers and success factors, both within the practice and beyond. When practices have collaborated and used their own ethnic-specific data in quality improvement techniques, they have improved Māori and Pacific health and equity. Attendees asked for greater practical support and guidance from the profession and sector. They report a funding gap for services needed by their patients to enable primary care to deliver equitable services for Māori and Pacific people.
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Affiliation(s)
- Gay Keating
- Te R?p? Rangahau Hauora A Eru P?mare, University of Otago, Wellington, New Zealand
| | - Richard Jaine
- Department of Public Health, University of Otago, Wellington, New Zealand
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Adelani MA, O’Connor MI. Perspectives of Orthopedic Surgeons on Racial/Ethnic Disparities in Care. J Racial Ethn Health Disparities 2016; 4:758-762. [DOI: 10.1007/s40615-016-0279-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 08/09/2016] [Accepted: 08/15/2016] [Indexed: 12/17/2022]
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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.
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Britton BV, Nagarajan N, Zogg CK, Selvarajah S, Schupper AJ, Kironji AG, Lwin AT, Cerullo M, Salim A, Haider AH. Awareness of racial/ethnic disparities in surgical outcomes and care: factors affecting acknowledgment and action. Am J Surg 2015; 212:102-108.e2. [PMID: 26522774 DOI: 10.1016/j.amjsurg.2015.07.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 06/22/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies have demonstrated racial/ethnic disparities in surgical outcomes and care. Surgeon awareness and its association with institutional action remain unclear. The study sought to assess surgeons' awareness of racial/ethnic disparities, ascertain whether demographic and practice factors influence acknowledgement of disparities, and determine whether surgeons are seeking to mitigate disparities. METHODS Anonymous online survey was administered to a random sample of American College of Surgeons (ACS) general surgeons (July 2013 to March 2014). Responses were weighted for nonresponse and risk-adjusted using logistic regression. RESULTS 172 surgeons completed the survey. Levels of acknowledged disparities were low. Less than one half reported institutional efforts to address disparities, and less than one fourth had taken efforts to investigate disparities in their personal practice. Several respondent factors including Academic Medical Center affiliation, awareness of the ACS statement on optimal access, and year of medical school graduation significantly associated with expressed acknowledgment of disparities. CONCLUSIONS Such associations speak to the need for continued efforts to promote enhanced provider awareness and participation. As the field of surgical disparities moves from understanding to action, we must acknowledge the contributing role that providers play.
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Affiliation(s)
- Breanne V Britton
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neeraja Nagarajan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA
| | - Shalini Selvarajah
- International Center for Spinal Cord Injury, The Kennedy Krieger Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Alexander J Schupper
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A Gatebe Kironji
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albert T Lwin
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marcelo Cerullo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali Salim
- Division of Trauma, Burns, and Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Adil H Haider
- Center for Surgery and Public Health, Harvard Medical School, Harvard T.H. Chan School of Public Health, and the Department of Surgery, Brigham and Women's Hospital, Boston, MA 02120, USA.
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Albert MA, Ayanian JZ, Silbaugh TS, Lovett A, Resnic F, Jacobs A, Normand SLT. Early results of Massachusetts healthcare reform on racial, ethnic, and socioeconomic disparities in cardiovascular care. Circulation 2014; 129:2528-38. [PMID: 24727094 DOI: 10.1161/circulationaha.113.005231] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. METHODS AND RESULTS Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality by race/ethnicity, education, and sex among Massachusetts residents aged 21 to 64 years hospitalized with a principal discharge diagnosis of ischemic heart disease before (November 1, 2004, to July 31, 2006) and after (December 1, 2006, to September 30, 2008) reform; 1-year mortality was calculated for those undergoing revascularization. Adjusted logistic regression assessed 24 216 discharges before reform and 20 721 discharges after reform. Blacks had 30% lower odds of receiving coronary revascularization than whites in the prereform period. Compared with whites in the postreform period, blacks (odds ratio=0.73; 95% confidence interval, 0.63-0.84) and Hispanics (odds ratio= 0.84; 95% confidence interval, 0.74-0.97) were less likely and Asians (odds ratio=1.29; 95% confidence interval, 1.01-1.65) were more likely to receive coronary revascularization. Patients living in more educated communities, men, and persons with private insurance were more likely to receive coronary revascularization before and after reform. Compared with the prereform period, the adjusted odds of in-hospital mortality were higher in patients living in less-educated communities in the postreform period. No differences in 1-year mortality by race/ethnicity, education, or sex for revascularized patients were observed before or after reform. CONCLUSIONS Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures.
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Affiliation(s)
- Michelle A Albert
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.).
| | - John Z Ayanian
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
| | - Treacy S Silbaugh
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
| | - Ann Lovett
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
| | - Fred Resnic
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
| | - Aryana Jacobs
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
| | - Sharon-Lise T Normand
- From the Divisions of Cardiovascular Medicine and Preventive Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, MA (M.A.A., F.R.); Division of General Medicine, Brigham and Women's Hospital, Boston, MA (J.Z.A.); Department of Health Care Policy, Harvard Medical School, Boston, MA (J.Z.A., A.L., S.T.N.); Lahey Clinic, Lahey, MA (F.R.); Department of Biostatistics, Harvard School of Public Health, Boston, MA (S.T.N.); Institute of Healthcare Policy, University of Michigan, Ann Arbor (J.Z.A.); and Division of Cardiovascular Medicine at Howard University and Howard University Hospital, Washington, DC (A.J.)
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Gonzalez CM, Kim MY, Marantz PR. Implicit bias and its relation to health disparities: a teaching program and survey of medical students. TEACHING AND LEARNING IN MEDICINE 2014; 26:64-71. [PMID: 24405348 DOI: 10.1080/10401334.2013.857341] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND The varying treatment of different patients by the same physician are referred to as within provider disparities. These differences can contribute to health disparities and are thought to be the result of implicit bias due to unintentional, unconscious assumptions. PURPOSES The purpose is to describe an educational intervention addressing both health disparities and physician implicit bias and the results of a subsequent survey exploring medical students' attitudes and beliefs toward subconscious bias and health disparities. METHODS A single session within a larger required course was devoted to health disparities and the physician's potential to contribute to health disparities through implicit bias. Following the session the students were anonymously surveyed on their Implicit Association Test (IAT) results, their attitudes and experiences regarding the fairness of the health care system, and the potential impact of their own implicit bias. The students were categorized based on whether they disagreed ("deniers") or agreed ("accepters") with the statement "Unconscious bias might affect some of my clinical decisions or behaviors." Data analysis focused specifically on factors associated with this perspective. RESULTS The survey response rate was at least 69%. Of the responders, 22% were "deniers" and 77% were "accepters." Demographics between the two groups were not significantly different. Deniers were significantly more likely than accepters to report IAT results with implicit preferences toward self, to believe the IAT is invalid, and to believe that doctors and the health system provide equal care to all and were less likely to report having directly observed inequitable care. CONCLUSIONS The recognition of bias cannot be taught in a single session. Our experience supports the value of teaching medical students to recognize their own implicit biases and develop skills to overcome them in each patient encounter, and in making this instruction part of the compulsory, longitudinal undergraduate medical curriculum.
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Affiliation(s)
- Cristina M Gonzalez
- a Department of Medicine , Albert Einstein College of Medicine/Montefiore Medical Center, Bronx , New York , New York , USA
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Roberts-Dobie S, Joram E, Devlin M, Ambroson D, Chen J. Differences in beliefs about the causes of health disparities in Black and White nurses. Nurs Forum 2013; 48:271-8. [PMID: 24188439 DOI: 10.1111/nuf.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether Black and White nurses' beliefs about causes of health disparities differ. CONCLUSIONS Analyses reveal that overall Black nurses perceived external factors to contribute significantly more to health disparities than White nurses. Black nurses considered four specific causes dealing with physician and societal factors, such as "discrimination in society," to be more significant contributors to health disparities than White nurses, whereas White nurses considered genetic factors to be a greater contributor. PRACTICE IMPLICATIONS Different views of the causes of health disparities are discussed, particularly in light of cultural competency training and other efforts to ameliorate health disparities.
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Affiliation(s)
- Susan Roberts-Dobie
- Health Promotion and Education, University of Northern Iowa, Cedar Falls, IA
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Abstract
BACKGROUND Ethnic minorities and low income families tend to be in poorer health and have worse outcomes for a spectrum of diseases. Health care provider bias has been reported to potentially affect the distribution of care away from poorer communities, minorities, and patients with a history of substance abuse. Trauma is perceived as a disease of the poor and medically underserved. Minorities are overrepresented in low income populations and are also less likely to possess health insurance leading to a potential overlapping effect. Traumatic brain injury (TBI) is a predominant cause of mortality and long-term morbidity, which imposes a considerable social and financial burden. We therefore sought to determine the independent effect on outcome after TBI from race, insurance status, intoxication on presentation, and median income. METHODS A 5-year retrospective chart review of admitted trauma patients aged 18 years and older to a Level I trauma center. Zip code of residency was a surrogate marker for socioeconomic status, because median income for each zip code is available from the US Census. Charts review included race, insurance status, mechanisms of trauma, and injuries sustained. Outcomes were placement of tracheostomy, hospital length of stay (HLOS), leaving Against Medical Advice (AMA), and discharge to home versus rehabilitation and mortality. RESULTS A total of 3,101 TBI patients were included in the analyses. Multivariable logistic and proportional hazard regression analyses were undertaken adjusting for age, gender, Injury Severity Score, and mechanism. Rates of tracheostomy placement were unaffected by race, median income, or insurance status. Race and median income did not affect HLOS, but private insurance was associated with shorter HLOS and intoxication was associated with longer HLOS. Neither race nor intoxication affected rates of AMA, but higher income and private insurance was associated with lower rates of AMA. Non-Caucasian race and lack of insurance had significantly lower likelihood of placement in a rehabilitation center. Mortality was unaffected by race, increased in intoxicated patients, was variably affected by median income, and was lowest in patients with private insurance. CONCLUSIONS An extremely complex interplay exists between socioethnic factors and outcomes after TBI. Few physicians would claim overt discrimination. Tracheostomy, the factor most directed by the surgeon, was unbiased by race, income, or insurance status. The likelihood of placement in a rehabilitation center was significantly impacted by both race and insurance status. Future prospective studies are needed to better address causation.
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18
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Burgess DJ. Addressing racial healthcare disparities: how can we shift the focus from patients to providers? J Gen Intern Med 2011; 26:828-30. [PMID: 21647749 PMCID: PMC3138990 DOI: 10.1007/s11606-011-1748-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Scott JM, Spees CK, Taylor CA, Wexler R. Racial Differences in Barriers to Blood Pressure Control in a Family Practice Setting. J Prim Care Community Health 2010; 1:200-5. [DOI: 10.1177/2150131910377645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Hypertension prevalence in the African American community is greater than in all other ethnic groups. Cultural perceptions of health and disease introduce barriers to providing effective care. The purpose of this study was to identify racial differences in the perceived causes of hypertension, current behaviors performed to control blood pressure, and perceived barriers to preventing or treating hypertension. Methods: A self-administered survey of patients seen for medical care in a primary care network was conducted. The survey was developed to measure perceptions of hypertension etiology and treatments. Data from African American (n = 69) and Caucasian (n = 218) respondents were used to assess racial differences in perceptions of blood pressure control. Results: About half of respondents knew their current blood pressures. African American patients were significantly less likely to believe that hypertension was caused by a lack of exercise and obesity. Significantly more Caucasians were less likely to report cutting down on table salt and taking prescription medications for blood pressure control. Both African Americans and Caucasians believed that sodium reduction was the most easily changed behavior to control their blood pressure, while both groups identified weight loss as being the most difficult. Conclusion: Racial differences exist in the perceived causes and treatments of high blood pressure, indicating a need for further patient education. When treating and counseling patients, physicians and support staff members must be sensitive to racial diversity and strive to offer culturally relevant solutions, especially for behaviors perceived as most difficult to change.
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21
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Rodriguez HP, Laugesen MJ, Watts CA. A randomized experiment of issue framing and voter support of tax increases for health insurance expansion. Health Policy 2010; 98:245-55. [PMID: 20655125 DOI: 10.1016/j.healthpol.2010.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 06/16/2010] [Accepted: 06/20/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effect of issue framing on voter support of tax increases for health insurance expansion. METHODS During October 2008, a random sample of registered voters (n=1203) were randomized to a control and two different 'framing' groups prior to being asked about their support for tax increases. The 'framing' groups listened to one of two statements: one emphasized the externalities or negative effects of the uninsured on the insured, and the other raised racial and ethnic disparities in health insurance coverage as a problem. All groups were asked the same questions: would they support tax increases to provide adequate and reliable health insurance for three groups, (1) all American citizens, (2) all children, irrespective of citizenship, and (3) all military veterans. RESULTS Support for tax increases varied substantially depending on which group benefited from the expansion. Consensus on coverage for military veterans was highest (83.3%), followed by all children, irrespective of citizenship (64.7%), and all American citizens (60.1%). There was no statistically significant difference between voter support in the 'framing' and control groups or between the two frames. In multivariable analyses, political party affiliation was the strongest predictor of support. CONCLUSIONS Voters agree on the need for coverage of military veterans, but are less united on the coverage of all children and American citizens. Framing was less important than party affiliation, suggesting that voters consider coverage expansions and related tax increases in terms of the characteristics of the targeted group, and their own personal political views and values rather than the broader impact of maintaining the status quo.
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Affiliation(s)
- Hector P Rodriguez
- Department of Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, CA 90095-1772, USA.
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Abstract
Racial and ethnic disparities are a pervasive and persistent problem in health care. This article has three main objectives: 1) To highlight key studies related to racial disparities in cardiovascular care and outcomes; 2) To explore determinants of disparities specifically related to access to renal transplantation as a model for understanding racial disparities in greater depth; and 3) To present promising approaches to eliminate racial disparities in care. Performance reports of the quality of medical and surgical care by race and ethnicity will be a crucial and expanding tool as more organizations ascertain complete data on their patients' race, ethnicity, language, and socioeconomic characteristics. Efforts to improve the quality of care and health outcomes of underserved racial and ethnic groups will also require effective coordination of care, patient-centered communication, and constructive engagement with communities to eliminate disparities in health care and health.
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Sequist TD, Ayanian JZ, Marshall R, Fitzmaurice GM, Safran DG. Primary-care clinician perceptions of racial disparities in diabetes care. J Gen Intern Med 2008; 23:678-84. [PMID: 18214625 PMCID: PMC2324133 DOI: 10.1007/s11606-008-0510-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 11/29/2007] [Accepted: 01/04/2008] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. OBJECTIVE The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. DESIGN The design of the study is through a survey of primary-care clinicians (response rate = 86%). PARTICIPANTS The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. MEASUREMENTS AND MAIN RESULTS We identified sociodemographic characteristics of each clinician's diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients' race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients' race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2-65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5-57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). CONCLUSIONS Most primary-care clinicians support the collection of data on patients' race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
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Alexander GC, Lin S, Sayla MA, Wynia MK. Development of a measure of physician engagement in addressing racial and ethnic health care disparities. Health Serv Res 2008; 43:773-84. [PMID: 18370978 PMCID: PMC2442375 DOI: 10.1111/j.1475-6773.2007.00780.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop a measure of physician engagement in addressing health care disparities. DATA SOURCES/STUDY DESIGN Cross-sectional survey of a national sample of physicians assessing each hypothesized component of engagement (Awareness, Reflection/Empowerment, and Action [AREA]). DATA COLLECTION/EXTRACTION METHODS Results examined using factorial analysis; predictive validity of final scale examined among highly engaged physicians. PRINCIPAL FINDINGS A nine-item scale derived from the AREA model has face validity, content validity, and applicability to a diverse group of physicians in measuring engagement. Partial correlations confirmed the mediating role of Reflection and/or Empowerment between Awareness and Action. Use of the scale among expert physicians suggests it reliably detects highly engaged physicians. CONCLUSIONS A nine-item survey can measure physician engagement in addressing health care disparities.
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Affiliation(s)
- G Caleb Alexander
- The University of Chicago, 5841 S. Maryland, MC 2007, Chicago, IL 60637, USA
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Watson KE, Fonarow GC. Adherence to best practices: How do patient race and gender affect physician performance? CURRENT CARDIOVASCULAR RISK REPORTS 2007. [DOI: 10.1007/s12170-007-0017-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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