Studying Provider Contribution to Health Disparities

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Studying Provider Contribution to Health Disparities

Goal:

 

  1. To identify and discuss the methods used to observe disparities in treatment and clinical decision-making by physicians;
  2. To speculate about an effective intervention to reduce provider-mediated disparities in care

 Readings:

  1. Sequist TD, et al. Physician performance and racial disparities in diabetes mellitus care. Archives of Internal Medicine, 2008; 168(11):1145-1151.
  2. Hasnain-Wynia R, et al. Disparities in health care are driven by where minority patients seek care. Archives of Internal Medicine, 2007; 167: 1233-1239.
  3. Zaslavsky AM and Ayanian JZ. Integrating research on racial and ethnic disparities in health care over place and time. Medical care, 2005; 43(4):303-307.

Questions:

 

 

  1. a. According to Zaslavsky editorial, what are the “relevant units” that contribute to variations in care (see pg 304, right column)?

              b. What (if any) does he fail to include?

      c. What statistical approach does he advocate for to account for these units? Try to state this simple, non-technical terms. Take a guess.

 

 

  1. In the Hasnain-Wynia article:
            a. What is the main objective of the study?

            b. What outcomes does she select to measure disparities? What are the “strengths” and “weaknesses” of these outcomes?

            c. What “relevant units” does she account for in her analyses? What (if any) are omitted?

            d. Do the authors seem to use the type of analysis that Zaslovsky advocates for? Explain.

            e. What is the main finding in this study – and how strongly are you persuaded by it?

 

  1. a. In the Sequist article, what is the main objective of the study?
             b. What are the “relevant units” accounted for in this study? In your view, are any omitted?

             c. In slightly different terms, what are factors that are accounted for in trying to explain patient outcomes? Are any omitted? Incorrectly included?

             d.  What is the main finding of this study?

              e. Is this study “generalizable” to other physicians/practices? Think about what you already know, and what MDs got into this study (see page 1146, top r                               column; page 1149, bottom right and continued on top).

 

4. Based on the readings from today (and everything else you know), describe an intervention you’d like to try to reduce health disparities. Describe the target population/level (e.g. drs, hospitals, health plans, etc), what the content of the intervention might be, and a specific outcome you’d measure.