Health/care Disparities Research Program
The Health/care Disparities Research Program fosters the conduct of high quality research to understand and alleviate inequities in health care, and to ensure the provision of exceptional health care without exception. The program also facilitates the training of a new generation of health care equity researchers. Program faculty are intellectual advocates for and leaders of health equity research both locally – within our own institution and city – and nationally. The Program is dedicated to understanding and addressing disparities in health and health care.
Section of General Internal Medicine
We hope to have a speaker on disparities issues four times a year. Check the Grand Rounds page for a list of speakers and the topic of discussion. When possible, we will post their slides and talk.
1) Center for Health Insurance Reform, Cardiovascular Outcomes, and Disparities
Principal Investigator: Nancy Kressin (Center PI)
Project #1 ”The Effects of Massachusetts Health Reform on Cardiovascular Outcomes and Disparities” PIs: Karen Lasser & Amresh Hanchate
Project #2 “Did Massachusetts Health Reform Reduce Disparities in Outcomes after Venous Thromboembolism, and at What Cost?” PIs: Adam Rose & Alok Kapoor
Massachusetts (MA) is the site of a key policy-relevant natural experiment, whereby recent legislation has resulted in nearly all (97%) of the state’s residents obtaining health insurance; it is thus the ideal setting in which to monitor and evaluate cardiovascular health outcomes, and disparities in such outcomes, associated with this policy change. Research to examine the impact of this natural experiment is needed to understand its effects on patient outcomes, including access to and use of care for cardiovascular conditions, clinical events, mortality, quality of life and costs associated with such use of care. Integral to the MA legislation was a goal to reduce racial and ethnic disparities in health; racial/ethnic, gender, language, and socioeconomic disparities in care and outcomes have been well documented by us and others. They are cause for great public health concern, and reducing disparities while improving outcomes has been proposed as a crucial goal for the national health promotion and disease prevention agenda, as described in Healthy People 2010.Within MA, the primary focus among policy makers has been on maximizing the proportion of the population who are now covered by insurance, and less on whether or how having insurance will affect individuals’ use/receipt of care, or on health outcomes related to insurance or use of care. We seek to understand the effects of MA health reform on health care and outcomes, and in disparities in each, through several research projects which share a common underlying question: Will expanded insurance coverage in MA be associated with improved health outcomes?
2) The Effects of Massachusetts Healthcare Reform on Access to Care and Disparities
Principal Investigator: Amresh Hanchate and Karen Lasser
Sponsor: Rx Foundation (Cambridge MA)
Closely related to the Center grant, we are comparing changes in MA vs. other states pre and post MA health reform.
- Hospital admission rates, and racial/ethnic disparities in such rates, and associated changes in inpatient costs for ambulatory care sensitive conditions including diabetes, pneumonia, asthma and COPD.
- Thirty-day readmission rates, and racial/ethnic disparities in such rates, and associated changes in inpatient costs for pneumonia.
- Rates, and disparities in such rates, of referral-sensitive procedures, namely hip and knee replacement.
3) Massachusetts Health Disparities Monitoring System
Principal Investigators: Nancy Kressin & Bill Adams (Pediatrics)
- Develop a powerful infrastructure to monitor cardiovascular risk factors and outcomes.
- Explore the effects of health reform and the economic downturn on disparities in health outcomes.
- Develop strategies for sharing tools and communicating results to policy makers, health care providers, and the research community.
4) Racial and Ethnic Disparities in Incidence and Inpatient Outcomes of Acute Stroke
Principal Investigator: Amresh Hanchate
We intend to identify and assess which potential factors influence “excess” risk of stroke incidence and adverse hospital outcomes for Non-Hispanic whites, non-Hispanic blacks and Hispanics. We propose to use data on all inpatient discharges during 2005-2007 from nine states (AZ, CA, FL, MA, NJ, NY, PA, SC and TX) with sizable minority populations.
- Estimate age and sex adjusted rates of the following indicators of acute stroke incidence and hospitalization outcomes by race/ethnic and SES cohorts of incidence rates for acute ischemic and hemorrhagic stroke, and outcomes for hospitalization (inpatient mortality, neurological impairment and length of hospital stay)
- Estimate the differences in prevalence across racial/ethnic and SES stratified cohorts of the indicators of the following potential factors: physiological risk factors (hypertension, diabetes), health behavior (smoking, exercise), geography (area-level primary care physician supply, distance to nearest hospital), hospital characteristics (volume of stroke patients) and access to care indicators (inadequate insurance, poverty, public assistance)
- Estimate the influence of the potential factors on “excess” rates of incidence and hospitalization outcomes among SES cohorts within same racial or ethnic group
5) Primary Care-based Patient Navigation to Promote Smoking Cessation Treatment
Principal Investigator: Karen Lasser
Sponsor: BU Department of Medicine
Cigarette smoking is a highly significant health threat, responsible for more than 430,000 deaths each year. Low-income persons and racial/ethnic minorities are at particularly high risk, smoking at greater rates and having greater tobacco-related morbidity and mortality than other persons. Yet poor and minority smokers are less likely to receive advice to stop smoking or to use tobacco cessation services. Using non-physician members of the health care team as patient navigators to connect low-income and minority smokers to evidence-based tobacco treatment services is a promising approach. Patient navigators are lay persons from the community, working as paid employees, who are trained to guide patients through the health care system to receive services. Information on the efficacy of patient navigation to connect vulnerable patients to smoking cessation services is needed. We are conducting a pilot study to determine the feasibility and acceptability of Patient Navigation. We will recruit 30 adult smokers engaged in primary care and conduct assessments at baseline and at 3 months.
- To develop a system of patient navigation in a primary care clinic setting, to promote engagement in smoking cessation treatment for poor and minority smokers
- To determine whether patient navigation increases the rates at which primary care patients engage in smoking cessation treatment
- To determine whether patient navigation increases rates at which primary care patients quit smoking, defined as biochemically verified self-report of 7-day point prevalence at six months.
Topics of Interest for Disparities Research:
Pediatric oral health care
Effects of the Massachusetts Health Reform
801 Massachusetts Avenue, Crosstown 2nd floor, Boston, MA 02118