Minority Health and Health Equity Archive
Permanent URI for this collectionhttp://hdl.handle.net/1903/21769
Welcome to the Minority Health and Health Equity Archive (MHHEA), an electronic archive for digital resource materials in the fields of minority health and health disparities research and policy. It is offered as a no-charge resource to the public, academic scholars and health science researchers interested in the elimination of racial and ethnic health disparities.
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Item Meaningful Disparities Reduction Through Research and Translation Programs(2011) Chin, M. H.; Goldmann, D.Health care disparities are unacceptable, but progress toward reducing them has been painfully slow. Each year the Agency for Healthcare Research and Quality's (AHRQ’s) National Healthcare Disparities Report documents persistent differences in care by factors such as race, ethnicity, and insurance status. 1 Public awareness of these disparities is growing, and the Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010 will hasten transparency by encouraging collection of race, ethnicity, and language data. However, recognizing the existence of disparities is not sufficient to catalyze meaningful action. Even the most motivated clinicians and health care organizations may not know how to proceed because information on which interventions work in specific contexts or at scale is limited. 2 There is broad agreement that meaningful efforts to reduce disparities are linked inextricably to quality improvement. In its 2001 report Crossing the Quality Chasm, the Institute of …Item Are There Racial Differences in Patients' Shared Decision-Making Preferences and Behaviors among Patients with Diabetes?(2011) Peek, M. E.; Tang, H.; Cargill, A.; Chin, M. H.Background. In the United States, African Americans are more likely to experience lower quality patient/provider communication and less shared decision making (SDM) than whites, which may be an important contributor to racial health disparities. Patient factors have not been fully explored as a potential contributor to communication disparities. Methods. The authors analyzed cross-sectional data from a survey of 974 patients with diabetes seen at 34 community health centers (HC) in 17 midwestern and west-central states. They used ordinal and logistic regression models to investigate racial differences in patients’ preferences for SDM and in patients’ behaviors that may facilitate SDM (initiating discussions about diabetes care). Results. The response rate was 67%. In bivariate and multivariate analyses, race was not associated with patient preference for a shared role in the 3 measured SDM domains: agenda setting (odds ratio [OR]: 1.13 [0.86, 1.49]), information sharing (OR: 1.26 [0.97, 1.64]), or decision making (OR: 1.16 [0.85, 1.59]). African Americans were more likely to report initiating discussions with their physicians about 4 of 6 areas of diabetes care—blood pressure measurement (66% v. 52%, P < 0.001), foot examination (54% v. 47%, P = 0.04), eye examination (57% v. 46%, P = 0.002), and microalbumin testing (38% v. 29%, P = 0.01)—but not HbA1c testing (39% v. 43%, P = 0.31) or cholesterol testing (53% v. 51%, P = 0.52). In multivariate analysis, African Americans were still more likely to report initiating conversations about diabetes care (OR: 1.78 [1.10, 2.89]). Conclusions. The authors found that African Americans in this study preferred shared decision making as much as whites and were more likely to report initiating more discussions with their doctors about their diabetes care. This research suggests that, among diabetes patients receiving care at community health centers, patient preference or patient behaviors may be an unlikely cause of racial differences in shared decision making.