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Pilot Projects Funded in 2010 Click on the name of the Pilot Project to view the related abstract:
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. School-Based Telemedicine Education for Rural Children with Asthma Tamara Perry, MD, Principal Investigator
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. Patient/Provider Perspectives on the Health Care Process: Formative Research M. Kate Stewart, MD, MPH, Principal Investigator
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.
UAMS Arkansas Center for Health Disparities
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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.
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.