Racial Disparities In Quality Research Articles

Collaborative Learning Among Health Care Organizations to Improve Quality and Advance Racial Equity.

The study examined stakeholder experiences of a statewide learning collaborative, sponsored and led by Blue Cross Blue Shield of Massachusetts (BCBSMA) and facilitated by the Institute for Healthcare Improvement (IHI) to reduce racial and ethnic disparities in quality of care. Interviews of key stakeholders (n=44) were analyzed to assess experiences of collaborative learning and interventions to reduce racial and ethnic disparities in quality of care. The interviews included BCBSMA, IHI, provider groups, and external experts. Breast cancer screening, colorectal cancer screening, hypertension management, and diabetes management were focal areas for reducing disparities. Collaborative learning methods involved expert coaching, group meetings, and sharing of best practices. Interventions tested included pharmacist-led medication management, strategies to improve the collection of race, ethnicity, and language (REaL) data, transportation access improvement, and community health worker approaches. Stakeholder experiences highlighted three themes: (1) the learning collaborative enabled the testing of interventions by provider groups, (2) infrastructure and pilot funding were foundational investments, but groups needed more resources than they initially anticipated, and (3) expertise in quality improvement and health equity were critical for the testing of interventions and groups anticipated needing this expertise into the future. BCBSMA's learning collaborative and intervention funding supported contracted providers in enhancing REaL data collection, implementing equity-focused interventions on a small scale, and evaluating their feasibility and impact. The collaborative facilitated learning among groups on innovative approaches for reducing racial disparities in quality. Concerns about sustainability underscore the importance of expertise for implementing initiatives to reduce racial and ethnic disparities.

Investigating racial disparities in quality-of-life years after pediatric hematopoietic stem cell transplant.

While racial disparities in the clinical outcomes of hematopoietic stem cell transplant (HSCT) patients have been explored, racial disparities in quality of life (QoL) during the re-adjustment phase after transplant are yet to be investigated in pediatric patients. The objective of this study was to examine the role of patient race in QoL at least 2years after pediatric HSCT. We conducted a retrospective chart review of patients under 21years of age at diagnosis who received an allogeneic transplant at our institution between January 2007 and December 2017. Patient QoL was assessed using the Pediatric Quality-of-Life Inventory Generic Score Scales (PedsQL TM 4.0) at least 2years post transplant. Patient demographic, treatment, and transplant outcome data were obtained for subsequent analysis, where patient race was categorized as either Black, White, Hispanic, or Native American. Data were collected on 86 pediatric patients who underwent HSCT. Forty patients (46.5%) were non-Hispanic White, 29 (33.7%) Hispanic, 10 (11.6%) Black, and seven (8.1%) Native American. Where preliminary analyses indicated a difference in QoL by patient race, there were no significant differences in physical, emotional, social, and school functioning by patient race after adjusting for transplant characteristics (age at transplant, sex, diagnosis, donor type, and conditioning regimen) and determinants of socioeconomic status (insurance type, estimated household income). Pediatric patients had comparable QoL, regardless of race, at a median of 3years after HSCT in our study cohort.

A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead.

The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities. Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life care for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities. We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence. The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality. The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.

Associations of Healthcare Affordability, Availability, and Accessibility with Quality Treatment Metrics in Patients with Ovarian Cancer.

Differential access to quality care is associated with racial disparities in ovarian cancer survival. Few studies have examined the association of multiple healthcare access (HCA) dimensions with racial disparities in quality treatment metrics, that is, primary debulking surgery performed by a gynecologic oncologist and initiation of guideline-recommended systemic therapy. We analyzed data for patients with ovarian cancer diagnosed from 2008 to 2015 in the Surveillance, Epidemiology, and End Results-Medicare database. We defined HCA dimensions as affordability, availability, and accessibility. Modified Poisson regressions with sandwich error estimation were used to estimate the relative risk (RR) for quality treatment. The study cohort was 7% NH-Black, 6% Hispanic, and 87% NH-White. Overall, 29% of patients received surgery and 68% initiated systemic therapy. After adjusting for clinical variables, NH-Black patients were less likely to receive surgery [RR, 0.83; 95% confidence interval (CI), 0.70-0.98]; the observed association was attenuated after adjusting for healthcare affordability, accessibility, and availability (RR, 0.91; 95% CI, 0.77-1.08). Dual enrollment in Medicaid and Medicare compared with Medicare only was associated with lower likelihood of receiving surgery (RR, 0.86; 95% CI, 0.76-0.97) and systemic therapy (RR, 0.94; 95% CI, 0.92-0.97). Receiving treatment at a facility in the highest quartile of ovarian cancer surgical volume was associated with higher likelihood of surgery (RR, 1.12; 95% CI, 1.04-1.21). Racial differences were observed in ovarian cancer treatment quality and were partly explained by multiple HCA dimensions. Strategies to mitigate racial disparities in ovarian cancer treatment quality must focus on multiple HCA dimensions. Additional dimensions, acceptability and accommodation, may also be key to addressing disparities.

Evaluation of Racial Disparities in Quality of Care for Patients With Gastrointestinal Tract Cancer Treated With Surgery

Racial disparities have been demonstrated in many facets of health care, but a comprehensive understanding of who is most at risk for substandard surgical care of gastrointestinal tract cancers is lacking. To examine racial disparities in quality of care of patients with gastrointestinal tract cancers. This retrospective cohort study of patients with gastrointestinal tract cancer included the US population as captured in the National Cancer Database with a diagnosis from January 1, 2004, to December 31, 2017. Participants included 565 124 adults who underwent surgical resection of gastrointestinal tract cancers. Data were analyzed from June 21 to December 23, 2021. Race and site of cancer. Oncologic standard of care, as defined by negative resection margin, adequate lymphadenectomy, and receipt of indicated adjuvant chemotherapy and/or radiotherapy. Among 565 124 adult patients who underwent surgical resection of a gastrointestinal tract cancer, 10.9% were Black patients, 83.5% were White patients, 54.7% were men, and 50.7% had Medicare coverage. The most common age range at diagnosis was 60 to 69 years (28.5%). Longer median survival was associated with negative resection margins (87.3 [IQR, 28.5-161.9] months vs 22.9 [IQR, 8.8-69.2] months; P < .001) and adequate lymphadenectomies (80.7 [IQR, 25.6 to not reached] months vs 57.6 [IQR, 17.7-153.8] months; P < .001). After adjustment for covariates, Black patients were less likely than White patients to have negative surgical margins overall (odds ratio [OR], 0.96 [95% CI, 0.93-0.98]) and after esophagectomy (OR, 0.71 [95% CI, 0.58-0.87]), proctectomy (OR, 0.71 [95% CI, 0.66-0.76]), and biliary resection (OR, 0.75 [95% CI, 0.61-0.91]). Black patients were also less likely to have adequate lymphadenectomy overall (OR, 0.89 [95% CI, 0.87-0.91]) and after colectomy (OR, 0.89 [95% CI, 0.87-0.92]), esophagectomy (OR, 0.72 [95% CI, 0.63-0.83]), pancreatectomy (OR, 0.90 [95% CI, 0.85-0.96]), proctectomy (OR, 0.93 [95% CI, 0.88-0.98]), proctocolectomy (OR, 0.90 [95% CI, 0.81-1.00]), and enterectomy (OR, 0.71 [95% CI, 0.65-0.79]). Black patients were more likely than White patients not to be recommended for chemotherapy (OR, 1.15 [95% CI, 1.10-1.21]) and radiotherapy (OR, 1.49 [95% CI, 1.35-1.64]) because of comorbidities and more likely not to receive recommended chemotherapy (OR, 1.68 [95% CI, 1.55-1.82]) and radiotherapy (OR, 2.18 [95% CI, 1.97-2.41]) for unknown reasons. These findings suggest that there are significant racial disparities in surgical care of gastrointestinal tract cancers. Black patients are less likely than White patients to receive standard of care with respect to negative surgical margins, adequate lymphadenectomies, and use of adjuvant therapies. Both system- and physician-level reforms are needed to eradicate these disparities in health care.

Racial Disparities in Pre-K Quality: Evidence From New York City’s Universal Pre-K Program

New York City’s universal prekindergarten (pre-K) program, which increased full-day enrollment from 19,000 to almost 70,000 children, is ambitious in both scale and implementation speed. We provide new evidence on the distribution of pre-K quality in New York City by student race/ethnicity, and investigate the extent to which observed differences are associated with the spatial distribution of higher quality providers. Relative to other jurisdictions, we find the average quality of public pre-K providers is high. However, we identify large disparities in the average quality of providers experienced by Black and White students, which is partially explained by differential proximity to higher quality providers. Taken together, current racial disparities in the quality of pre-K providers may limit the program’s ability to reduce racial achievement gaps.

Accountable care organizations and racial and ethnic disparities among patients with Alzheimer’s and related dementia diseases

AbstractBackgroundThe accountable care organization (ACO) is a new care coordination model and reimbursement mechanism that incentivizes providers to deliver high‐quality and well‐coordinated care. This study is the first to provide evidence on the ACOs enrollment and quality of enrolled ACOs among patients with ADRD, and evidence associated with racial disparities in quality of care for persons with ADRD.MethodOur study used 2017 Centers for Medicare and Medicaid Services Medicare inpatient claims data and Medicare Beneficiary Summary File. Our study focused on patients who had a diagnosis of ADRD. We further linked the CMS claims data with the 2017 MSSP ACO data to capture the patient’s participation of the ACO. The CMS ACO quality measures were used to examine the quality of the ACOs among those who enrolled in the ACOs. In this study, we examined four 4 ACO quality measures related to hospital care quality: risk standardized, all condition readmission (ACO 8), all‐cause unplanned admissions for patients with diabetes (ACO 36), heart failure (ACO 37), and multiple chronic conditions (ACO 38). Finally, we merged our data with the 2017 American Community Survey, Area Health Resource File, and the American Hospital Annual survey to capture the geographic and hospital characteristics.ResultsIn 2017, 37% of Medicare beneficiaries with ADRD were enrolled in the ACO. Substantial variation of the ACO participation by patients’ races and ethnicities was observed, ranging from 38% among the white to 14% among the Native ADRD patients. Regression results showed that compared to white, African American, Hispanic, Asian, and Native Medicare beneficiaries with ADRD were significantly less likely to enroll in the ACOs. Among those enrolled in the ACOs, we further observed ACO 8, ACO 36, ACO 37, ACO 38 were significantly higher, i.e. worse quality, among African American, Hispanic, and Native ADRD patients.ConclusionsResults suggested that policymakers should create incentives for minority‐serving providers to participate in ACOs and provide minority‐serving ACOs with structural assistance to ensure that they can successfully attain their performance goals.

Effect of the Patient-Centered Medical Home on Racial Disparities in Quality of Care.

Research demonstrates that the patient-centered medical home (PCMH) is associated with improved clinical outcomes and quality of care, and the populations that can most benefit from this model require long-term management, e.g., persons with chronic illness and behavioral health conditions. However, different populations may not benefit equally from the PCMH, and empirical evidence about the effects of this model on racial disparities is limited. Estimate the association between enrollment in National Committee for Quality Assurance (NCQA)-recognized PCMHs and racial disparities in quality of care for adults with major depressive disorder (MDD) and comorbid medical conditions. Applying a quasi-experimental instrumental variable design to account for differential selection into the PCMH, we used generalized estimating equations to determine the probability of receiving eight disease-specific quality measures. Medicaid enrollees in three states not dually enrolled in Medicare, ages 18-64 with MDD and > 1 other chronic condition. A subgroup analysis was conducted for enrollees with comorbid diabetes. Enrollment in an NCQA-recognized PCMH. Disease-specific quality indicators for MDD (e.g., antidepressant use, receipt of psychotherapy), and for diabetes, (e.g.A1c testing, LDL-C testing, retinal exams, and medical attention for nephropathy). PCMH enrollment was associated with an increase in the overall likelihood of receiving six of eight recommended services and a decrease in the likelihood of receiving any psychotherapy (4.94 percentage points, p < 0.01) and retinal exams (5.51 percentage points, p < 0.05). Although both groups improved, PCMH enrollment was associated with an exacerbation of the Black-white disparity in adequate antidepressant use by 4.20 percentage points (p < 0.01). While PCMH enrollment may improve the overall quality of care, the effect is inconsistent across racial groups and not always associated with reductions in racial disparities in quality.

Trends and Disparities in Quality of Diabetes Care in the US: The National Health and Nutrition Examination Survey, 1999-2016.

Objectives: To examine trends and disparities in the quality of diabetes care among US adults with diabetes. Methods: Individuals aged 20 years or older with diabetes from NHANES (1999-2016) were included in the study. Quality indicators for diabetes care included Hemoglobin A1c (HbA1c) < 8%, Blood Pressure (BP) < 130/80 mm Hg, Low-Density Lipoprotein (LDL-C) < 100 mg/dL, triglycerides < 150 mg/dL, receiving eye and foot examinations in the past year, and meeting with a diabetes educator in the past year. Results: A total of 7,521 adults with diabetes were identified. During the 18-year study period, significant improvements in diabetes care were observed in the overall study sample. Adjusted regression analyses showed that compared with their White counterparts, Blacks were more likely to have received eye (OR=1.37; P=0.01) and foot (OR=1.42;P=0.01) examinations and met a diabetes educator (OR=1.40;P<0.01) over the past year. However, Blacks were significantly less likely to achieve treatment goals for HbA1c (OR=0.77, P=0.02), BP (OR=0.75, P<0.01), LDL-C (OR=0.68, P<0.01). Hispanics in general had suboptimal healthcare utilization for diabetes but the Hispanic-white disparities in diabetes care outcomes were attenuated after controlling for patient sociodemographic, clinical and utilization characteristics. Overall, suboptimal quality of diabetes care were particularly prominent among adults without health insurance and those with lower educational attainment. Conclusions: In the United States, despite persistent efforts, racial disparities in quality of diabetes care still persist. Lack of health insurance and lower socioeconomic status are among the strongest predictors of poor quality of diabetes care. These findings provide valuable information in developing policies and practices to promote racial equity in diabetes care.

Assessment of Gender and Racial Disparities in Quality of Care Indicators for Inflammatory Bowel Disease

Introduction: Gender and racial inequality in healthcare quality has been extensively documented. Furthermore,high variation in the care received by inflammatory bowel diseases (IBD) patients has also been reported. We aimed to assess potential gender or racial disparities in adherence to established IBD quality of care indicators (QIs) by gastroenterologists practicing in the community and in a specialized IBD practice at an academic medical center. Methods: A prospective review of consecutive outpatient visits at the gastroenterology clinic at a tertiary academic medical center was conducted over 4 months (January-April 2017). Demographic information and QIs developed by the AGA and CCFA including documentation of IBD phenotype, vaccination status, corticosteroid usage, and appropriate endoscopic evaluation were recorded. We analyzed for gender and racial (Caucasian vs. African American) differences in QIs using t-test and Chi square test. (Prism, Irving CA). Results: Over the study period, 478 patients (median age 42 years, 51% female, 14% African American) were evaluated in the IBD clinics. Disease duration was a median of 14 years, and 55% had Crohn's disease. There was no significant gender (male vs. females) differences in QIs: IBD phenotype documentation (67% vs. 68%), HBV vaccination (74% vs. 69%), Influenza vaccination (54% vs. 50%), Pneumovax vaccination (31% vs. 35), and steroid use greater than 12 weeks (25% vs. 28%), colorectal cancer surveillance (58% vs. 64%), endoscopy within 6 months of modifying therapy (45% vs. 39%). There were no significant racial (Caucasian vs. African American) differences in adherence to most QIs: IBD phenotype documentation (71% vs 67%), HBV vaccination (71% vs. 76%), Influenza vaccination (50% vs. 66%, p=0.01), Pneumovax vaccination(32% vs 42%, p=0.08), steroid use greater than 12 weeks (26% vs 28%), colorectal cancer surveillance (65% vs. 60%), and endoscopy within 6 months of modifying therapy (46% vs. 37%,). In addition, race and gender did not contribute to significant differences in QIs in subgroups of patients managed either by community general gastroenterologists vs IBD specialists at an academic medical center. Conclusion: There was no consistent evidence of gender or racial disparities in adherence to most of the quality of care indicators in IBD either in community or specialized IBD practices. This requires confirmation in future studies replicated at other community and academic IBD practices.

Disparities in Health Care Quality among Asian Children with Special Health Care Needs.

There is a dearth of information on the quality of health care for Asian American children and particularly Asian children with special health care needs (CSHCN). The goal of this article was to determine whether there were disparities in quality of health care for Asian CSHCN, whose experiences have not been studied. Data were derived from the 2009-2010 National Survey of Children with Special Health Care Needs (ns=355 non-Hispanic Asian children and 4,343 non-Hispanic white CSHCN). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between racial identity (that is, non-Hispanic white and non-Hispanic Asian) and quality of health care. Racial disparities in quality of health care were substantial between Asian and white CSHCN in 2009-2010. Asian parents were significantly less likely than white parents to report that their health care provider provided the specific information they needed, helped them feel like a partner in their child's care, and was sensitive to the family's values and customs. The development and testing of specific, targeted policy and practice interventions to reduce disparities in health care quality for these children are urgently needed.

Abstract A43: A System-Change and Community-Based Participatory Research Approach to Understanding the Role of Informal Social Networks During the Cancer Care Journey

Abstract Background: Racial disparities in quality and completion of cancer treatment have been associated with poorer health outcomes among African Americans (AA) compared to White Americans (WA). Support from informal social networks – such as family members and friends - during the cancer care journey is critical. Yet, few studies have examined system-level factors associated with family and friend involvement in cancer care and whether system-level factors contribute to racial variations in their involvement. The purpose of this study is to investigate (a) cancer survivor perceptions on involvement of and effects from their informal social network during their cancer journey, (b) healthcare system factors that influenced the type and degree of network involvement, and (c) racial differences in survivor/network member experiences with the healthcare system during the cancer journey. Methods: Accountability for Cancer Care through Undoing Racism and Equity”, a 5-year system-change intervention trial funded by the National Cancer Institute, is a community-based participatory research (CBPR) partnership of the University of North Carolina at Chapel Hill (UNC), Greensboro Health Disparities Collaborative, and two cancer centers. ACCURE aims to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients at the two partner cancer centers. As part of the formative work for this study, focus groups were conducted with Black and White early-stage breast and lung cancer survivors to understand how encounters with the healthcare system influenced their treatment experience (diagnosis through survivorship). Our racially diverse CBPR partnership developed, conducted, and analyzed focus group data from 8 focus groups with early stage breast and lung cancer survivors at the two cancer centers: 4 focus groups with AA survivors (n=12) and 4 focus groups with WA survivors (n=15). Results: Informal network member involvement was associated with barriers to care patients encountered in the cancer system; aspects of cancer care that helped to facilitate patient care and treatment; and, racial differences in critical encounters with the health system. Involvement with and health related experiences of family members and friends also influenced survivor interactions with the health care system, though differences by race were observed. Conclusion: Cancer survivors identified several healthcare system factors that influenced the nature of social network member involvement during cancer care, with some differences by race. Implications for system-changes to improve care for early-stage breast and lung cancer patients and survivors, and considerations of family and friend involvement in care, will be discussed. Citation Format: Katrina R. Ellis, Jennifer Schall, Stephanie Baker, Kristin Zenee Black, Carol Cothern, Kia Davis, Kay Doost, Eugenia Eng, Christina Goettsch, Fatima Guerrab, Christina Hardy, Alexandra Lightfoot, Neda Padilla, Cleo Samuel. A System-Change and Community-Based Participatory Research Approach to Understanding the Role of Informal Social Networks During the Cancer Care Journey. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A43.

Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time?

Racial disparities in access to care and access to high-quality care have been persistent over many decades. They have been documented in all areas of health care, including ambulatory care. Policy initiatives have been implemented to address disparities and close the gaps in care that minorities face. Less is known about the effectiveness of these polices. To evaluate whether disparities in quality of ambulatory care have abated during the decade of 2000 by answering 2 questions: (1) were there differences in ambulatory care sensitive hospital admissions rates by race?; (2) have these differences been declining over time? Multivariable linear regressions with fixed county effects and robust SEs of longitudinal panel data. A total of 4,032,322 discharges in 172 counties in 6 states during 2003-2009. Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality, by county, and race calculated from the Healthcare Cost and Utilization Project dataset. In 2003 the overall PQI admission rates were higher for African Americans (around 16.5/1000) than for whites (around 15/1000). By 2009, the overall and the chronic PQI admission rates declined significantly (P<0.01) for whites. They either did not decline or increased for African Americans. Acute PQI rates declined significantly for whites and remained stable for African Americans. Policies addressing persisting racial disparities in quality of ambulatory care for African Americans should focus on the chronic PQIs. In addition, efforts should be made to improve data quality for race and ethnicity information on hospital discharge data to enable informed policy evaluation and planning.

Quality of care and racial disparities in medicare among potential ACOs.

The Medicare Accountable Care Organization (ACO) programs encourage integration of providers into large groups and reward provider groups for improving quality, but not explicitly for reducing health care disparities. Larger group size and better overall quality may or may not be associated with smaller disparities. To examine differences in patient characteristics between provider groups sufficiently large to participate in ACO programs and smaller groups; the association between group size and racial disparities in quality; and the association between quality and disparities among larger groups. Using 2009 Medicare claims for 3.1 million beneficiaries with cardiovascular disease or diabetes and linked data on provider groups, we compared racial differences in quality by provider group size, adjusting for patient characteristics. Among larger groups, we used multilevel models to estimate correlations between group performance on quality measures for white beneficiaries and black-white disparities within groups. Four process measures of quality, hospitalization for ambulatory care-sensitive conditions (ACSCs) related to cardiovascular disease or diabetes, and hospitalization for any ACSC. Beneficiaries served by larger groups were more likely to be white and live in areas with less poverty and more education. Larger group size was associated with smaller disparities in low-density lipoprotein (LDL) cholesterol testing and retinal exams, but not in other process measures or hospitalization for ACSCs. Among larger groups, better quality for white beneficiaries in one measure (hospitalization for ACSCs related to cardiovascular disease or diabetes) was correlated with smaller racial disparities (r = 0.28; P = 0.02), but quality was not correlated with disparities in other measures. Larger provider group size and better performance on quality measures were not consistently associated with smaller racial disparities in care for Medicare beneficiaries with cardiovascular disease or diabetes. ACO incentives rewarding better quality for minority groups and payment arrangements supporting ACO development in disadvantaged communities may be required for ACOs to promote greater equity in care.

Abstract PR05: The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association.

Abstract Purpose of study: The study aim was to assess associations between various acculturation measures and self-rated health (SRH), as well as potential mediation by spiritual well-being and cancer self-efficacy of any associations. Experimental procedure: Secondary analysis of data from a cross-sectional telephone survey of a population-based registry sample of 330 self-identified Latina breast cancer survivors was conducted. Multivariate logistic regression models assessed relationships between acculturation measures (i.e., the Short Acculturation Scale for Hispanics (SASH), country of birth (foreign or U.S. born), and English proficiency (main predictor)) and SRH (outcome). The role of cancer self-efficacy (measured with a version of the Cancer Behavior Inventory CBI-B) and spiritual well-being subscales (Sense of Peace/Meaning and Faith) of the Functional Assessment of Chronic Illness Therapy as mediators was also assessed in multivariate logistic regression models. New Data: The sample mean age was 58.3 years (range 30-90 years; SD 11.9), about 60% were foreign-born and approximately half were English proficient (EP, speaks English well/very well) vs. limited English proficient (LEP, speaks English not at all/poorly/fairly well). Approximately 70% were of Mexican origin, about 70% had a high school education or less, and two-thirds were privately insured. Almost all were 2-3 years post-diagnosis (283; 85.8%). The mean cancer self-efficacy score was 3.43 (SD 0.59; range 1-4). The mean sense of peace/meaning score was 26.6 (SD 5.31; range 0-32) and the mean faith score was 14.20 (SD 2.99; range 0-16). About one-quarter of the women reported poor or fair SRH. In unadjusted analyses of the acculturation measures, English proficiency demonstrated the strongest association with SRH; women who were EP were more likely than LEP women to rate their health as good/very good/excellent (OR= 2.26 CI= 1.15, 4.45, p&amp;lt;0.000). Country of birth and SASH scores were related to SRH at p&amp;lt;0.15. Greater cancer self-efficacy (OR= 2.24 CI= 1.22, 4.10, p&amp;lt;0.001) and sense of peace/meaning (OR= 3.00 CI= 1.66, 5.44, p&amp;lt;0.001) were associated significantly with better SRH; faith was not. In multivariate models English proficiency was associated significantly with SRH independent of other sociodemographic characteristics (OR=2.26; 95% CI 1.15, 4.45). Adding cancer self-efficacy to the model attenuated the effect of English proficiency on SRH (OR=1.76, 95% CI 0.87, 3.55), and self-efficacy was positively associated with SRH (OR=2.24, 95% CI 1.22, 4.10). In the final model, adding sense of peace/meaning was associated independently with SRH (OR= 2.44, 95% CI 1.30, 4.56) and attenuated the association of self-efficacy and SRH (OR=1.67, 95% CI 0.88, 3.18). Conclusion: The association of English proficiency with SRH was partially mediated by cancer self-efficacy and sense of peace/meaning, with the latter explaining much of the effect. Findings support development of interventions for Latina breast cancer survivors that target modifiable resiliency factors, like sense of peace/meaning or self-efficacy, to address racial disparities in quality of life (QOL) and SRH for Latina breast cancer survivors; particularly for those at risk of poorer QOL and SRH given English proficiency limitations. This abstract is also presented as Poster B25. Citation Format: Maria DeLourdes Garcia-Jimenez, Jasmine Santoyo-Olsson, Carmen Ortiz, Anna M. Napoles. The effect of language on the self-rated health of Latina breast cancer survivors: Cancer self-efficacy and spiritual well-being as potential mediators of this association. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR05.

Health Information Technology and Disparities in Quality of Care

Health Information Technology and Disparities in Quality of Care

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Background The quality of medication use in older adults is suboptimal, with a large percentage of individuals not receiving recommended care. Most efforts to evaluate the quality of medication use target high-risk drugs, appropriate treatment of prevalent chronic disease states, or a set of predefined quality indicators of medication use rather than the patient. It is also suggested that racial differences in the quality of medication use may exist in older adults. Objective This study was conducted to determine the prevalence, number, and types of medication-related problems in older adults, examining the impact of race on quality medication use. Methods This was a prospective cohort study involving in-home interviews and medical record reviews of community-residing older adults, stratified by race, conducted 3 times over 1 year. No intervention to address medication-related problems was performed. The quality of medication use was reported as medication-related problems by clinical pharmacists. Results Of the 200 participants (100 blacks, 100 whites), mean age was 78.3 (whites) and 75.5 (blacks), and the majority of patients were female. Although whites used more medications than blacks (mean, 11.6 vs 9.7; P < 0.01), blacks had more medication-related problems per person than whites (mean, 6.3 vs 4.9; P < 0.01). All patients had at least 1 medication-related problem. Common problems at baseline, 6 months, and 12 months for both whites and blacks were undertreatment, suboptimal drug use, suboptimal dosing, nonadherence, and less costly alternative available. Blacks had significantly higher rates of nonadherence than whites (68% vs 42%; P < 0.01). Over the 12-month study, the number of medication-related problems not only persisted but increased (adjusted P = 0.0168). Conclusions Medication-related problems were prevalent in both black and white older adults and persisted over 1 year. Blacks had more medication-related problems than whites, including higher rates of nonadherence. These findings require further study to better understand racial disparities in the quality of medication use in older adults and the impact of race on specific medication-related problems.

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Racial Disparities in Quality of Medication Use in Older Adults: Findings From a Longitudinal Study

Racial disparities in quality of care in community-acquired pneumonia

In population-based studies, blacks had higher risk of severe sepsis and mortality compared with whites, but the reasons for these differences are unknown. We examined racial differences in quality of care and outcomes in subjects hospitalized with community-acquired pneumonia (CAP).

Separate And Unequal: Racial Segregation And Disparities In Quality Across U.S. Nursing Homes

We describe the racial segregation in U.S. nursing homes and its relationship to racial disparities in the quality of care. Nursing homes remain relatively segregated, roughly mirroring the residential segregation within metropolitan areas. As a result, blacks are much more likely than whites to be located in nursing homes that have serious deficiencies, lower staffing ratios, and greater financial vulnerability. Changing health care providers' behavior will not be sufficient to eliminate disparities in medical treatment in nursing homes. Persistent segregation among homes poses a substantial barrier to progress.