Research Triangle Institute Research Articles

Race/ethnicity and human epidermal growth hormone receptor 2–targeted therapy for breast cancer.

91 Background: Breast cancer is the most common cancer in the US. Up to 25% of breast cancers are classified as human epidermal growth factor receptor 2 (HER2)-positive and associated with an aggressive tumor burden. HER2-targeting monoclonal antibodies improves survival in patients with HER2-positive breast cancer. Prior work has demonstrated disparities in access to oncologic therapies among older women. Our study seeks to examine racial/ethnic disparities in receiving HER2-targeted therapies for patients with HER2-positive breast cancer and trends in use over time. Methods: In the Surveillance, Epidemiology and End Results (SEER) Medicare-linked database we identified women diagnosed with breast cancer from 2010 to 2019. We included those >66 years old who survived 12 months after diagnosis, were enrolled in Medicare Parts A/B for 12 months pre and post-diagnosis, and had local or regional stage HER2-positive cancer. Our primary outcome was receipt of HER2-targeted therapies in the 12 months after diagnosis. Our independent variable was race/ethnicity as measured by the validated Research Triangle Institute race/ethnicity codes in Medicare. Due to small sample sizes, we focus our analysis on White, Black, or Hispanic women. We used multivariable Modified Poisson regression to evaluate changes in the probability of HER2-targeted therapy receipt by race/ethnicity over time, adjusted for sociodemographics, cancer factors, and medical comorbidities. Results: Our cohort comprised 13,887 patients including 8.7% Black, 7.5% Hispanic, and 83.8% White (mean age 74.9). Overall, 7,351 (52.9%) received HER2-targeted therapies in the 12 months post-diagnosis, with use increasing over time in all racial/ethnic groups (Table). Compared with White patients, Black and Hispanic patients had a 19% (adjusted risk ratio [aRR] 0.81, 95% CI:0.69-0.96) and 27% (aRR 0.73, 95% CI 0.61-0.89) lower likelihood, respectively, of receiving HER2-targeted therapies from 2010-2011 (Table). By 2018-2019, no significant differences in receiving HER2-targeted therapies were observed across racial/ethnic groups. Conclusions: In a national cohort of Medicare enrollees with HER2-positive breast cancer, we observed significant racial/ethnic disparities which narrowed over time. Overall utilization rates were low. Future work is needed to understand how improved access to breast cancer treatments impact downstream outcomes. Use of human epidermal growth hormone receptor 2–targeted therapy from 2010-2011 and 2018-2019 by race/ethnicity. Race and Ethnicity Unadjusted Rates Adjusted Risk Ratios (95% CI)* 2010-2011 2018-2019 2010-2011 2018-2019 Black 36% 62% 0.81 (0.69-0.96) 0.97 (0.87-1.08) Hispanic 31% 68% 0.73 (0.61-0.89) 1.01 (0.92-1.12) White 42% 64% Reference Reference *Adjusted for age, marital status, region, breast cancer stage and year of diagnosis, and medical comorbidities.

Patient-Provider Communication and Colorectal Cancer Screening Completion Using Multi-target Stool DNA Testing.

Colorectal cancer (CRC) screening continues to be underutilized in the USA despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Understanding how patient-provider communication influences CRC screening can inform interventions to improve screening completion. We developed a behavioral theory-informed survey to identify patient-provider communication factors associated with multi-target stool DNA (mt-sDNA) screening completion. The survey was administered by RTI International between 03/2022 and 06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021 and 9/2021. Respondents completed an electronic or paper survey. Multivariable logistic regression was used to identify patient-provider communication factors associated with mt-sDNA test completion. A total of 2973 participants completed the survey (response rate, 21.7%) and 81.6% of them (n = 2427) reported having had a conversation with provider about mt-sDNA testing before the test was ordered. Having a conversation with the provider about the test, including discussions about costs, the need for follow-up testing and test instructions were associated with higher odds of test completion and being "very likely" to use the test in the future. Lack of discussion about advantages and disadvantages of available CRC screening options and lack of patient involvement in CRC screening decision-making were associated with reduced odds of test completion and likelihood of future use. Healthcare providers play a key role in patient adherence to CRC screening and must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

Analysis of risk of bias assessments in a sample of intervention systematic reviews, Part II: focus on risk of bias tools reveals few meet current appraisal standards

ObjectivesRisk of bias (RoB) assessment is a critical part of any systematic review (SR). There are multiple tools available for assessing RoB of the studies included in a SR. The conduct of these assessments in intervention SRs are addressed by three items in AMSTAR-2, considered the preferred tool for critically appraising an intervention SR. This study focuses attention on item 9, which assesses the ability of a RoB tool to adequately address sources of bias, particularly in randomized trials (RCTs) and nonrandomized studies of interventions (NRSI). Our main objective is to report the detailed results of our examination of both Cochrane and non-Cochrane RoB tools and distinguish those that meet AMSTAR-2 item 9 appraisal standards. Study Design and SettingWe identified critical appraisal tools reported in a sample of 126 SRs reporting on interventions for persons with cerebral palsy published from 2014 to 2021. Eligible tools were those that had been used to assess the primary studies included in these SRs and for which assessment results were reported in enough detail to allow appraisal of the tool. We identified the version of the tool applied as original, modified, or novel and established the applicable study designs as intended by the tools’ developers. We then evaluated the potential ability of these tools to assess the four sources of bias specified in AMSTAR-2 item 9 for RCTs and NRSI. We adapted item 9 to appraise tools applied to single-case experimental designs, which we also encountered in this sample of SRs. ResultsMost of the eligible tools are recognized by name in the published literature and were applied in the original or modified form. Modifications were applied with considerable variability across the sample. Of the 37 tools we examined, those judged to fully meet the appraisal standards for RCTs included all the Cochrane tools, the original and modified Downs and Black Checklist, and the quality assessment standard for a cross-over study by Ding et al; for NRSI, these included all the Cochrane tools, the original and modified Downs and Black Checklist, and the Research Triangle Institute item bank on Risk of Bias and Precision of Observational Studies for NRSI. In general, tools developed for a specific study design were judged to meet the appraisal standards fully or partially for that design. These results suggest it is unlikely that a single tool will be adequate by AMSTAR-2 item 9 appraisal standards for an intervention SR that includes studies of various designs. ConclusionTo our knowledge, this is the first resource providing SR authors with practical information about the appropriateness and adequacy of RoB tools by the appraisal standards specified in AMSTAR-2 item 9 for RCTs and NRSI. We propose similar methods for appraisal of tools applied to single-case experimental design. We encourage authors to seek contemporary RoB tools developed for use in healthcare-related intervention SRs and designed to evaluate relevant study design features. The tools should address attributes unique to the review topic and research question but not be subjected to unjustified and excessive modifications. We promote recognition of the potential shortcomings of both Cochrane and non-Cochrane RoB tools, even those that perform well by AMSTAR-2 item 9 appraisal standards.

Perspectives on U.S. University research reactor policy

Abstract Widely promoted by the Atomic Energy Commission in the 1950s and 1960s, university research reactors allowed faculty to experiment with neutron scattering, advancing our understanding of organic and inorganic materials. These advances led to innovations in commercial products, including automobiles, computers, medicine, and batteries. However, since the 1980s, more than half of all the university research reactors have been decommissioned and remaining reactors are ill-suited for modern needs. RTI International assembled a team of economists, neutron scientists, and policy analysts to examine the history of university research reactor policy in the USA, assess barriers to greater usage, and consider how US policy differs from those in other countries. We present three policy options to enhance the role of university research reactors in federal research and the national science infrastructure landscape.

Racial and ethnic inequities in spatial access to pharmacies: A geographic information system analysis

BackgroundPharmacy accessibility is crucial for equity in health care access because community pharmacists may reach individuals who do not have access to other health care providers. ObjectiveThe objective of this study was to determine whether spatial access to pharmacies differs among racial/ethnic groups across the rural-urban continuum. MethodsWe obtained a 30% random sample of the Research Triangle Institute synthetic population, sampled at the census block level. For each individual, we defined optimal pharmacy access as having a driving distance ≤2 miles to the closest pharmacy in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. We used a logistic regression model to measure the association between race/ethnicity and pharmacy access, while controlling for racial/ethnic composition of the census tract, area deprivation index, income, age, gender, and U.S. region. The model included an interaction between race/ethnicity and urbanicity to evaluate whether racial/ethnic inequities differed across the rural-urban continuum. ResultsThe sample included 90,749,446 individuals of whom 80.6% had optimal pharmacy access. Racial/ethnic inequities in pharmacy access differed across the rural-urban continuum (P value for interaction= <0.0001). In rural areas, Black (OR 0.87; 95% CI 0.86-0.87), Hispanic (OR 0.80; 95% CI 0.79-0.80), and indigenous (OR 0.47; 95% CI 0.47-0.48) individuals had lower odds of optimal pharmacy access, than White individuals. Hispanic (OR 0.96; 95% CI 0.96-0.97) and Indigenous individuals (OR 0.75; 95% CI 0.75-0.76) had lower odds of optimal pharmacy access compared to White individuals in suburban areas. In Western states, Asian had lower odds of optimal pharmacy access in suburban (OR 0.88; 95% CI 0.86-0.90) and rural areas (OR 0.91; 95% CI 0.87-0.95) compared to White individuals. ConclusionsRacial/ethnic inequities in spatial access to community pharmacies vary between urban and rural communities. Underrepresented racial/ethnic groups have significantly lower pharmacy access in rural and some suburban areas, but not in urban areas.

Impacts of educational interventions of librarian instruction on health information seeking attitudes and behaviors in an employee wellness program.

Health literacy and its potential impacts on the wellbeing of patrons remain a highly regarded objective among health science and medical librarians when considering learning outcomes of patron communities. Librarians are positioned to champion literacy instruction activities. This study aimed to examine health information seeking attitudes and behaviors in an academic-based employee wellness program before and after health literacy workshops were developed and facilitated by an academic health sciences librarian. The intervention included instruction informed by Don Nutbeam's Health Literacy Framework and the Research Triangle Institute's Health Literacy Conceptual Framework. Sixty-five participants obtained through convenience sampling attended workshops and were invited to respond to pre- and post-session surveys. Using a quantitative quasi-experimental methodology, surveys collected health literacy indicators including preferred sources and handling practices of in-person and online health information. Findings indicated workshops influenced information seeking behaviors as participants documented a decrease in social media use for health and wellness information (-36%) and medical information (-13%). An increase in the usage of consumer health databases (like Medline Plus) was also indicated post-workshop for health and wellness information (18%) and medical information (31%). Favorable impacts are evident in this small-scale study; however, more research is needed to confirm the influence of these methods on larger and more diverse populations. Librarians should continue to develop and disseminate theory-informed tools and methods aimed at engaging various communities in constructive health information seeking practices.

Contribution of Procurement Procedures to the Achievement of Non-Profit Organizations Objectives: Case of RTI International

Contribution of Procurement Procedures to the Achievement of Non-Profit Organizations Objectives: Case of RTI International

Advancing progress on tobacco control in low-income and middle-income countries through economic analysis

BackgroundMore than 80% of the world’s 1.3 billion tobacco users live in low-income and middle-income countries (LMICs), where progress to address tobacco and its harms has been slow. The perception...

Racial and Ethnic Disparities in Opioid Prescribing on Hospital Discharge Among Older Adults: A National Retrospective Cohort Study.

Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults. To determine filled opioid prescription rates on hospital discharge by race/ethnicity among Medicare beneficiaries. Retrospective cohort study. Medicare beneficiaries 65 years or older discharged from hospital in 2016, without opioid fills in the 90 days prior to hospitalization (opioid-naïve). Race/ethnicity was categorized by the Research Triangle Institute (RTI), grouped as Asian/Pacific Islander, Black, Hispanic, other (American Indian/Alaska Native/unknown/other), and White. The primary outcome was an opioid prescription claim within 2 days of hospital discharge. The secondary outcome was total morphine milligram equivalents (MMEs) among adults with a filled opioid prescription. Among 316,039 previously opioid-naïve beneficiaries (mean age, 76.8 years; 56.2% female), 49,131 (15.5%) filled an opioid prescription within 2 days of hospital discharge. After adjustment, Black beneficiaries were 6% less likely (relative risk [RR] 0.94, 95% CI 0.91-0.97) and Asian/Pacific Islander beneficiaries were 9% more likely (RR 1.09, 95% CI 1.03-1.14) to have filled an opioid prescription when compared to White beneficiaries. Among beneficiaries with a filled opioid prescription, mean total MMEs were lower among Black (356.9; adjusted difference - 4%, 95% CI - 7 to - 1%), Hispanic (327.0; adjusted difference - 7%, 95% CI - 10 to - 4%), and Asian/Pacific Islander (328.2; adjusted difference - 8%, 95% CI - 12 to - 4%) beneficiaries when compared to White beneficiaries (409.7). Black older adults were less likely to fill a new opioid prescription after hospital discharge when compared to White older adults and received lower total MMEs. The factors contributing to these differential prescribing patterns should be investigated further.

Tools for assessing quality of studies investigating health interventions using real-world data: a literature review and content analysis

ObjectivesWe aimed to identify existing appraisal tools for non-randomised studies of interventions (NRSIs) and to compare the criteria that the tools provide at the quality-item level.DesignLiterature review through three approaches:...

Effects of indoor air pollution on clinical outcomes in patients with interstitial lung disease: protocol of a multicentre prospective observational study

BackgroundIdiopathic pulmonary fibrosis (IPF) is a chronic progressive fibrosing interstitial lung disease with a poor prognosis. While there is evidence suggesting that outdoor air pollution affects the clinical course of...

HARMONIZATION OF SELF-REPORTED RACE/ETHNICITY TO ENHANCE HEALTH EQUITY RESEARCH USING MEDICARE DATA

Abstract Collection of valid race and ethnicity data is critical to understanding and promoting health equity. However, current administrative data often misclassifies members of the racial/ethnic minority groups. To address this issue, the Research Triangle Institute (RTI) developed an imputed race variable, which improves on administrative race data for Hispanic and Asian beneficiaries, but still has limitations. This study compares the RTI race with our new, harmonized, self-reported race/ethnicity data collected during Medicaid enrollment and post-acute and long-term care assessments. Out of 2,322,071 Medicare beneficiaries aged 18 and older who died in 2019 in the U.S., self-reported race/ethnicity was available for 75.1% (1,745,327) who formed the study population. Compared to the RTI race variable, our new race variable categorized more Medicare beneficiaries as non-Hispanic white (79.5% vs. 77.9%) and Asian American/Pacific Islander (2.5% vs. 2.3%), a similar percentage as American Indians/Alaska Native (0.5% vs. 0.5%), and slightly fewer as Black (11.1% vs. 10.9%) and Hispanic (7.2% vs. 6.5%). Using our new race variable as the gold-standard, RTI race had good validity (k=0.81), however sensitivity was highest for non-Hispanic white (96.5) and Black (95.8) beneficiaries, and lower for Hispanic (87.2), Asian American/Pacific Islander (76.2), and American Indian/Alaska Native (58.7) beneficiaries. These findings are consistent with prior work, comparing RTI race with self-reported race from a single data source. Our study provides empirical evidence to support the U.S. Office of the Inspector General’s recommendations to the Centers for Medicare and Medicaid Services to incorporate self-reported race/ethnicity data available to reduce error and bias.

Personal Exposure to Fine Particulate Air Pollution among Brick Workers in Nepal

Prior studies suggest brick workers in Nepal may be chronically exposed to hazardous levels of fine particulate matter (PM2.5) from ambient, occupational, and household sources. However, findings from these studies were based on stationary monitoring data, and thus may not reflect a worker’s individual exposures. In this study, we used RTI International’s MicroPEMs to collect 24 h PM2.5 personal breathing zone (PBZ) samples among brick workers (n = 48) to estimate daily exposures from ambient, occupational, and household air pollution sources. Participants were sampled from five job categories at one kiln. The geometric mean (GM) PM2.5 exposure across all participants was 116 µg/m3 (95% confidence interval [CI]: 94.03, 143.42). Job category was significantly (p &lt; 0.001) associated with PBZ PM2.5 concentrations. There were significant pairwise differences in geometric mean (GM) PBZ PM2.5 concentrations among workers in administration (GM: 47.92, 95% CI: 29.81, 77.03 µg/m3) vs. firemen (GM: 163.46, 95 CI: 108.36, 246.58 µg/m3, p = 0.003), administration vs. green brick hand molder (GM: 163.35, 95% CI: 122.15, 218.46 µg/m3, p &lt; 0.001), administration vs. top loader (GM: 158.94, 95% CI: 102.42, 246.66 µg/m3, p = 0.005), firemen vs. green brick machine molder (GM: 73.18, 95% CI: 51.54, 103.90 µg/m3, p = 0.03), and green brick hand molder vs. green brick machine molder (p = 0.008). Temporal exposure trends suggested workers had chronic exposure to hazardous levels of PM2.5 with little to no recovery period during non-working hours. Multi-faceted interventions should focus on the control of ambient and household air pollution and tailored job-specific exposure controls.

Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control

Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the “Why” and “How” of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45–75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that “Why” information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while “How” information was positively associated with perceived ease of use. “Why” information contributed to screening intention through perceived effectiveness while “How” information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients’ self-efficacy in completing their preferred screening option.

Evaluating PM2.5 element concentration measurements for a nationwide monitoring network

ABSTRACT Particulate matter (PM) concentrations have decreased dramatically over the past 20 years, thus lower method detection limits (MDL) are required for these measurements. Energy-dispersive X-ray fluorescence (XRF) spectroscopy is used to quantify multiple elements simultaneously in the U.S. Environmental Protection Agency (EPA) Chemical Speciation Network (CSN). Inductively-coupled plasma mass spectrometry (ICP-MS) is an alternative analysis with lower MDL for elements. Here, we present a side-by-side comparison of XRF and ICP-MS for elements in PM2.5 samples collected via the EPA’s CSN. For ICP-MS, a simple extraction and ICP-MS analysis technique was applied to a wide variety of samples to minimize effort and cost and serve as a feasibility test for a large monitoring network. Filter samples (N = 549) from various urban locations across the US were analyzed first analyzed via XRF at UC Davis and then ICP-MS at RTI International. Both methods measured 29 of the same elements out of the 33 usually reported to CSN. Of these 29, 14 elements (Na, Mg, Al, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, Pb) were found to be frequently detected (i.e. had more than 10% of values above both XRF and ICP-MS MDL). ICP-MS was found to have lower MDL for 26 out of 29 elements, namely Na, Mg, Al, Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, As, Se, Rb, Sr, Zr, Ag, Cd, In, Sn, Sb, Cs, Ba, Ce, Pb; conversely, XRF had lower MDL for 3 elements, namely, P, K, Zn. Intra-method quality checks using (1) inter-elemental inspection of scatter plots using a priori knowledge of element sources and (2) scatter plots of routine versus collocated measurements reveal that ICP-MS exhibits better measurement precision. Lower detection limits for element measurements in nationwide PM monitoring networks would benefit human-health and source apportionment research. Implications: We demonstrate that ICP-MS with adilute-acid digestion method would significantly improve the element detection rates and thus be avaluable addition to the current analysis techniques for airborne PM samples in anationwide monitoring network. In this paper, we show that a hybrid method of elemental analysis for airborne particulate matter (PM) would significantly improve the detection rates for elements in PM. This would be a valuable addition to the current analysis techniques for airborne PM samples in nationwide and other large-scale monitoring networks, such as the EPA’s Chemical Speciation Network (CSN). The techniques explored in this study (i.e., X-ray Fluorescence Spectroscopy or XRF and Inductively Coupled Plasma-Mass Spectrometry or ICP-MS) are relevant to the PM monitoring and regulatory community audience of JAWMA, especially agencies and states that are already involved in CSN. In addition, our results outline considerations that give insight on factors to consider for other large-scale and long-term ambient air monitoring efforts.

Understanding polysubstance use at the daily and event levels: protocol for a mixed-methods qualitative and ecological momentary assessment study in a community-based sample of people who use illicit drugs in Oakland, California, USA

IntroductionPolysubstance use is extremely common among people who use illicit opioids in the USA. It is associated with poor substance use treatment outcomes, infectious disease risk and alarming rates of...

Fear of crime and the willingness to report crime to police: A case study of model policing in Meta-Mercado, Coatepeque, Guatemala

ABSTRACT Community-oriented policing has been a mainstay of policing over the past quarter century. In March 2019, the municipality of Coatepeque in Guatemala, with the assistance of Research Triangle Institute (RTI) International, implemented a new community policing plan called Vivir y Prosperar in the Meta Mercado. Vivir y Prosperar was designed to improve security, reduce crime, and promote economic prosperity. This study utilises the pre-test, baseline and 6-months post-test, endline survey data of market vendors in the Meta Mercado to assess whether Vivir y Prosperar reduced fear of crime and increased someone’s willingness to report crime to police as tenets of community policing would anticipate. Results show that Vivir and Prosperar did not directly contribute to a decrease in fear of crime or improve one’s willingness to report crimes to the police. However, improving personal victimisation experiences, bribery payments, and other factors may indirectly promote a reduction in fear of crime and increase the willingness to report a crime among market vendors.

An examination of psychometric properties of study quality assessment scales in meta-analysis: Rasch measurement model applied to the firefighter cancer literature.

Most existing quality scales have been developed with minimal attention to accepted standards of psychometric properties. Even for those that have been used widely in medical research, limited evidence exists supporting their psychometric properties. The focus of our current study is to address this gap by evaluating the psychometrics properties of two existing quality scales that are frequently used in cancer observational research: (1) Item Bank on Risk of Bias and Precision of Observational Studies developed by the Research Triangle Institute (RTI) International and (2) Newcastle-Ottawa Quality Assessment Scale (NOQAS). We used the Rasch measurement model to evaluate the psychometric properties of two quality scales based on the ratings of 49 studies that examine firefighters' cancer incidence and mortality. Our study found that RTI and NOQAS have an acceptable item reliability. Two raters were consistent in their assessment, demonstrating high interrater reliability. We also found that NOQAS has more items that show better fit than the RTI scale. The NOQAS produced lower study quality scores with a smaller variation, suggesting that NOQAS items are much easier to rate. Our findings accord with a previous study, which conclude that the RTI scale was harder to apply and thus produces more heterogenous quality scores than NOQAS. Although both RTI and NOQAS showed high item reliability, NOQAS items are better fit to the underlying construct, showing higher validity of internal structure and stronger psychometric properties. The current study adds to our understanding of the psychometric properties of NOQAS and RTI scales for future meta-analyses of observational studies, particularly in the firefighter cancer literature.

In Case You Haven't Heard…

For those readers who are NSDUH (National Survey on Drug Use and Health) nerds, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a new, second survey. The Mental and Substance Use Disorders Prevalence Study (MDPS) includes gaps not covered by the NSDUH: Those who do not reside in households; including homeless, institutionalized or incarcerated populations. These populations, according to SAMHSA, have disproportionately high rates of mental health and substance use disorders. Between October 2020 and October 2022, this study, conducted in partnership with the research organization, RTI International, conducted 5,679 clinical interviews among 18–65‐year‐olds, including those living in households, prisons, state psychiatric hospitals and homeless shelters. For the MDPS, released last week, click HERE.

Assessing the validity of race and ethnicity coding in administrative Medicare data for reporting outcomes among Medicare advantage beneficiaries from 2015 to 2017.

To assess the validity of race/ethnicity coding in Medicare data and whether misclassification errors lead to biased outcome reporting by race/ethnicity among Medicare Advantage beneficiaries. In this national study of Medicare Advantage beneficiaries, we analyzed individual-level data from the Health Outcomes Survey (HOS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), race/ethnicity codes from the Medicare Master Beneficiary Summary File (MBSF), and outcomes from the Medicare Provider Analysis and Review (MedPAR) files from 2015 to 2017. We used self-reported beneficiary race/ethnicity to validate the Medicare Enrollment Database (EDB) and Research Triangle Institute (RTI) race/ethnicity codes. We measured the sensitivity, specificity, and positive and negative predictive values of the Medicare EDB and RTI codes compared to self-report. For outcomes, we compared annualized hospital admission, 30-day, and 90-day readmission rates. Data for Medicare Advantage beneficiaries who completed either the HOS or CAHPS survey were linked to MBSF and MedPAR files. Validity was assessed for both self-reported multiracial and single-race beneficiaries. For beneficiaries enrolled in Medicare Advantage, the EDB and RTI race/ethnicity codes have high validity for identifying non-Hispanic White or Black beneficiaries, but lower sensitivity for beneficiaries self-reported Hispanic any race (EDB: 28.3%, RTI: 85.9%) or non-Hispanic Asian American or Native Hawaiian Pacific Islander (EDB: 56.1%, RTI: 72.1%). Only 8.7% of beneficiaries self-reported non-Hispanic American Indian Alaska Native are correctly identified by either Medicare code, resulting in underreported annualized hospitalization rates (EDB: 31.5%, RTI: 31.6% vs. self-report: 34.6%). We find variation in 30-day readmission rates for Hispanic beneficiaries across race categories, which is not measured by Medicare race/ethnicity coding. Current Medicare race/ethnicity codes misclassify and bias outcomes for non-Hispanic AIAN beneficiaries, who are more likely to select multiple racial identities. Revisions to race/ethnicity categories are needed to better represent multiracial/ethnic identities among Medicare Advantage beneficiaries.