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Pilot Projects Funded in 2010

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Click here to view the Pilot Projects funded in 2007

The Contribution of Obesity to Poor Quality of Care Among Elderly Nursing Home Residents

Holly Felix, PhD, MPA, Principal Investigator

Racial and ethnic health disparities in chronic disease, disability and death are well documented, with African Americans having higher mortality rates and higher prevalence rates of many health conditions compared to whites, including higher rates of obesity. Disparities also exist with the quality of medical care, with African Americans receiving less than standard care for many conditions including colorectal cancer, coronary artery disease, and stroke. These unfortunate disparities in care persist into other health settings, including nursing homes. African Americans are more likely than whites to be residents of nursing homes having the highest number of deficiencies in quality, including deficiencies actually causing harm. Research has also shown that obesity is associated with receipt of poorer quality of care in medical care settings and nursing homes. Given the association between obesity and functional decline as well as nursing home admission, and higher rates of obesity among African American elders, it is possible that obesity is contributing to the poorer quality of care received by African American elders in nursing homes. LTC is an area of significant public policy importance given the current volume of usage, the likely increased demand with the aging of the Baby Boomers, and the substantial public resources invested into it. Efforts to improve the LTC quality exist; however, these efforts are not addressing disparities in quality by race or weight status. Furthermore, reducing racial and ethnic disparities is a national health priority. However, no known research has investigated the relationship of race and obesity on nursing home quality of care. Therefore, the purpose of this proposed pilot project is to explore the interaction of obesity and race on nursing home quality of care in Arkansas using one year of data from the Minimum Data Set. The results of this exploratory research will inform the development of a research proposal to further investigate and explore the interactive effects of obesity and race on nursing home quality of care across with US and ultimately improve access to quality LTC for all persons regardless of race or weight.

For more information contact:
Holly Felix, PhD
UAMS College of Public Health
4301 W. Markham, Slot 820
Little Rock, AR 72205
Telephone: (501) 526-6626



School-Based Telemedicine Education for Rural Children with Asthma

Tamara Perry, MD, Principal Investigator

Asthma is the most common chronic illness of childhood and a major cause of childhood disability. Children from ethnic minority and low-income groups suffer disproportionately and have increased risk for asthma diagnosis, morbidity, and death. Nationwide data on asthma prevalence and morbidity reveal that these risks exist for minority and low-income children, whether living in urban or rural children are lacking. Implementation of national asthma guidelines has been shown to successfully improve asthma outcomes; however, there is a significant and persistent gap between well-established recommendations for appropriate asthma care and actual care received particularly among minority and low-income children. Children in these groups are significantly less likely to receive adequate asthma education and more likely to receive inadequate medical therapy for their level of disease severity. These disparities in asthma care are even more pronounced in severely medically underserved regions such as the Mississippi Delta Region of Arkansas. Our central hypothesis is that an innovative school-based asthma telehealth intervention utilizing national asthma guidelines will improve asthma health outcomes in a predominately minority, low-income pediatric population in the Delta Region of Arkansas. Our translational approach will utilize national evidence-based asthma guidelines to: 1) provide comprehensive asthma education to children with asthma and their caregivers and 2) provide physician prompts to the primary care provider based on the child’s longitudinal asthma symptoms profile. The Delta Region of Arkansas is one of the most medically underserved and impoverished regions of the United States and high rates of asthma prevalence, asthma morbidity, and asthma mortality have been identified by our research team. The proposed study will test the effectiveness of a school-based telehealth intervention on asthma outcomes, as well as child and caregiver quality of life, asthma knowledge, and self-efficacy among a high-risk pediatric population. Data from the proposed project will directly inform public health policies and outreach strategies to improve rural health outcomes, not only in asthma but also in other chronic health conditions, in high risk and underserved pediatric populations. Data will be used as critical preliminary and feasibility data in a future RO1 application.

For more information contact:
Tamara Perry, MD
UAMS College of Medicine
4301 W. Markham, Slot 512-13
Little Rock, AR 72205
Telephone: (501) 364-1060



Physician Characteristics, Patient Race, and Disparities in Health Care

Qayyim Said, PhD, Principal Investigator

There is increasing evidence that racial and ethnic minorities receive lower quality care and have lower access to health care. Understanding the sources and types of racial disparities in health care is critical for designing effective interventions to reduce these disparities. Association of patient level characteristics with provision of quality care has been well researched and documented. However, a question is whether variations in quality of care could be explained by physician characteristics. A further question of interest is to explore disparities across races and ethnicities by employing physician level data along with physician perspective. Specifically, an inquiry into physician characteristics including physicians' racial and ethnic background and its interaction with patients' racial and ethnic characteristics warrants attention.

The current study proposes to determine if and to what extent a physician’s patient racial composition is related to the structural quality of care provided by the physician and to determine if patient racial composition is related to access to secondary and specialty care. This study will shed light on the extent to which minority patients are accessing physician providers that have lower structural quality, such as fewer informational technologies that can improve the quality of care. The study will also explore the extent to which minority patients are accessing physician providers who have characteristics associated with poor access to secondary and specialty care. The specific aims of the study are: (1) To investigate the relationship between patient racial composition and physician characteristics including physician race, with physician practice structural quality of care measures, (2) To investigate the relationship between patient racial composition and physician characteristics including physician race, with access to secondary and specialty care.

Exploring whether racial differences exist within physician or across physician providers is important to appropriately design strategies to reduce racial disparities. If the primary driver of disparities is across providers, or in other words, minorities accessing lower quality providers, strategies to mitigate these disparities may be best achieved by designing interventions to improve the overall quality of care provided to physicians caring for minority patients, expanding access to a broader range of providers in minority areas, or providing tools to help minority patients identify high quality providers.

For more information contact:
Qayyim Said, PhD
UAMS College of Pharmacy
4301 W. Markham, Slot 522
Little Rock, AR 72205
Telephone: (501) 686-7702



Patient/Provider Perspectives on the Health Care Process: Formative Research

M. Kate Stewart, MD, MPH, Principal Investigator

Women with chronic diseases such as cancers of the reproductive system, sexually transmitted diseases, hypertension, and diabetes frequently receive care from Obstetrics and Gynecology (Ob/Gyn) providers, and racial disparities in care for these conditions have been documented (Smedley et al., 2003; AHRQ, 2008; Mayberry, 2000). The Institute of Medicine study, Unequal Treatment, defines healthcare disparities as "racial or ethnic differences in the quality of healthcare that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention" (Smedley et al., 2003), and identifies determinants operating at the systems level as well as through individual discrimination such as provider bias and stereotyping. Research has shown physicians are more likely to have negative perceptions of African American than white patients, even after controlling for patient gender, age, income, and education (Van Ryn and Burke, 2002), and that they communicate less effectively with non-white than white patients (Saha et al., 2003; Siminoff et al, 2006; Johnson et al., 2004). A fundamental issue in addressing such racial healthcare disparities then, is the need to reduce such, often unconscious, provider bias (Burgess et al., 2007). Provider empathy has been highlighted as an important ingredient not only in overcoming bias but also in effective patient communication (Burgess et al., 2007; Hojat, 2007; Neumann et al. 2009). However, more research is needed to identify effective interventions for achieving less biased and more empathetic care. The overall purpose of the study proposed, then, is to conduct formative research with University of Arkansas for Medical Sciences (UAMS) Ob/Gyn faculty, residents, students, and patients to develop an intervention designed to reduce provider racial bias and improve empathetic communication. Subsequent funding will be sought to pilot the intervention and conduct a full-scale trial if feasibility is determined. The specific aims of this pilot are to: 1) Identify patient and provider perceptions and levels of empathy and provider bias to inform an empathetic communication intervention for providers and students, where the primary outcome is empathy, and the secondary outcomes are patient outcomes; 2) Use the qualitative and quantitative data collected to adapt preexisting cultural competency and provider empathy interventions to reduce racial bias and improve empathetic communication among providers and students; and 3) Prepare and submit a larger grant application to test the intervention's feasibility and, subsequently, its efficacy in reducing racial bias and enhancing provider empathetic communication.

For more information contact:
M. Kate Stewart, MD, MPH
UAMS College of Public Health
4301 W. Markham, Slot 820
Little Rock, AR 72205
Telephone: (501) 526-6625



Enhancing Healthy Food Environments: Exploring Influences on Food Store Selection

Delia Smith West, PhD and Rebecca Krukowski, PhD, Principal Investigators

Dietary intake and weight status play a significant role in many of the most common chronic diseases that contribute to health disparities. Healthy foods have been shown to be less available in predominately African-American communities and in low income neighborhoods; thus, reduced availability of healthy foods in these neighborhoods may present a barrier to health disparity risk reduction by dietary change or obesity prevention. A better understanding of how individuals select their primary food store (e.g., proximity to home or work, store appearance, healthy food availability, prices, presence of other merchandise) and the role that healthy food availability may play in this decision process would inform policies and programs to promote environmental changes which encourage dietary change and obesity prevention. Therefore, this project aims to: 1) explore factors relevant to choosing a food store (supermarket, smaller grocery stores, convenience stores, etc) and the perceptions of at risk individuals (i.e., African-American, low-income and rural populations) about their food store's role in what they eat, using focus group methodology; 2) using these qualitative data, develop and refine a questionnaire that can be utilized in future research examining intervention strategies for making healthier food choices or altering food environments; and 3) using focus group methodology, explore interest in and begin to develop community-based interventions to create healthier shopping patterns. Ethnically-diverse focus groups from both urban and rural areas will be conducted to assure that the questionnaire is culturally appropriate for the food outlets commonly available in communities most vulnerable to obesity and diet-associated health disparities. The questionnaire will be piloted in a second ethnically-diverse sample to establish psychometric properties of the questionnaire. Consistent with the research goals of the Arkansas Center for Health Disparities, at the end of the project, a refined, psychometrically-sound questionnaire appropriate for diverse communities (including African-American, low-income and rural at-risk populations) will be available for research focused on the role of the food environment in contributing to health disparities and for interventions to reduce these disparities.

For more information contact:
Delia Smith West, PhD                        Rebecca Krukowski, PhD
UAMS College of Public Health              UAMS College of Public Health 
4301 W. Markham, Slot 820                 4301 W. Markham, Slot 820
Little Rock, AR 72205                          Little Rock, AR 72205
Email:                 Email:
Telephone: (501) 526-6623                 Telephone: (501) 686-8366




UAMS Arkansas Center for Health Disparities
4301 W. Markham #Slot 820, Little Rock, AR 72205, 501-526-6707

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