Browsing by Author "Cooper, Lisa A"

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    Designing and evaluating interventions to eliminate racial and ethnic disparities in health care.
    (2002) Cooper, Lisa A; Hill, Martha N; Powe, Neil R
    A large number of factors contribute to racial and ethnic disparities in health status. Health care professionals, researchers, and policymakers have believed for some time that access to care is the centerpiece in the elimination of these health disparities. The Institute of Medicine's (IOM) model of access to health services includes personal, financial, and structural barriers, health service utilization, and mediators of care. This model can be used to describe the interactions among these factors and their impact on health outcomes and equity of services among racial and ethnic groups. We present a modified version of the IOM model that incorporates the features of other access models and highlights barriers and mediators that are relevant for interventions designed to eliminate disparities in U.S. health care. We also suggest that interventions to eliminate disparities and achieve equity in health care services be considered within the broader context of improving quality of care. Some health service intervention studies have shown improvements in the health of disadvantaged groups. If properly designed and implemented, these interventions could be used to reduce health disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. However, in order to be effective in reducing disparities in health care and health status, important limitations of previous studies need to be addressed, including the lack of control groups, nonrandom assignment of subjects to experimental interventions, and use of health outcome measures that are not validated. Interventions might be improved by targeting high-risk populations, focusing on the most important contributing factors, including measures of appropriateness and quality of care and health outcomes, and prioritizing dissemination efforts.
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    Disparities in Care for Depression Among Primary Care Patients
    (2004) Miranda, Jeanne; Cooper, Lisa A
    CONTEXT: Ethnic minorities traditionally receive less care for depression than do white populations; we examine ethnic minority care for depression in a large cross-national primary care sample. DESIGN: This is a cross-sectional study of identification and treatment of depression among diverse primary care patients, using self-report of symptoms and care. SUBJECTS: One thousand four hundred and ninety-eight depressed primary care patients participating in four large studies of quality improvement for depression care are examined at baseline. RESULTS: Primary care providers recommend depression treatments for Latino and African-American patients as frequently as they do for white patients. However, Latino and African-American patients are less likely to take antidepressant medications (adjusted odds ratio [OR], 0.30; 95% confidence interval [CI], 0.21 to 0.42 and adjusted OR, 0.56; 95% CI, 0.36 to 0.87, respectively) and Latinos are less likely to obtain specialty mental health care (adjusted OR, 0.50; 95% CI, 0.36 to 0.75). CONCLUSIONS: Primary care providers are now able to recognize depression and recommend treatment for Latino and African-American patients, with this care recommended at equal rates to that of white patients. However, Latino and African-American patients remain less likely to obtain appropriate care, such as antidepressant medications or specialty care. New approaches to improving access to appropriate care for Latino and African-American primary care patients are needed.
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    DISPARITIES IN PATIENT EXPERIENCES, HEALTH CARE PROCESSES, AND OUTCOMES: THE ROLE OF PATIENT–PROVIDER RACIAL, ETHNIC, AND LANGUAGE CONCORDANCE
    (The Commonwealth Fund, 2004) Cooper, Lisa A; Powe, Neil R
    Ethnic minorities are poorly represented among physicians and other health professionals. In what is called “race-discordant” relationships, patients from ethnic groups frequently are treated by professionals from a different ethnic background. The research reviewed here documents ongoing racial and ethnic disparities in health care and links patient–physician race and ethnic concordance with higher patient satisfaction and better health care processes. Based on this research, the authors issue the following recommendations: 1) health policy should be revised to encourage workforce diversity by funding programs that support the recruitment of minority students and medical faculty; 2) health systems should optimize their providers’ ability to establish rapport with minority patients to improve clinical practice and health care delivery; 3) cultural competency training should be incorporated into the education of health professionals; and 4) future research should provide additional insight into the mechanisms by which concordance of patient and physician race, ethnicity, and language influences processes and outcomes of care.
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    Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions
    (2006) Beach, Mary; Gary, Tiffany L; Price, Eboni G; Robinson, Karen; Gozu, Aysegul; Palacio, Ana; Smarth, Carole; Jenckes, Mollie; Feuerstein, Carolyn; Bass, Eric B; Powe, Neil R; Cooper, Lisa A
    Abstract available at publisher's web site.
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    Patient–Physician Relationships and Racial Disparities in the Quality of Health Care
    (2003) Saha, Somnath; Arbelaez, Jose J; Cooper, Lisa A
    Objectives. This study explored whether racial differences in patient–physician relationships contribute to disparities in the quality of health care. Methods. We analyzed data from The Commonwealth Fund’s 2001 Health Care Quality Survey to determine whether racial differences in patients’ satisfaction with health care and use of basic health services were explained by differences in quality of patient–physician interactions, physicians’ cultural sensitivity, or patient–physician racial concordance. Results. Both satisfaction with and use of health services were lower for Hispanics and Asians than for Blacks and Whites. Racial differences in the quality of patient–physician interactions helped explain the observed disparities in satisfaction, but not in the use of health services. Conclusions. Barriers in the patient–physician relationship contribute to racial disparities in the experience of health care.