Assessing Quality of Care for African Americans with Hypertension

Abstract

African Americans bear a disproportionate burden of hypertension. A causal-modeling design, using Donabedian's Quality Framework, tested hypothesized relationships among structure, process, and outcome variables to assess quality of care provided to this population. Structural assessment revealed that administrative and staff organization affected patients' trust in their provider and satisfaction with their care. Interpersonal process factors of racism, cultural mistrust, and trust in providers had a significant effect on satisfaction, and perceived racism had a negative effect on blood pressure (BP). Poorer quality in technical processes of care was associated with higher BP. Findings support the utility of Donabedian's framework for assessing quality of care in a disease-specific population.

System-Justifying Beliefs Moderate the Relationship Between Perceived Discrimination and Resting Blood Pressure

“…Research examining the relationship between perceived discrimination and resting BP, however, has yielded mixed results. Some studies show a direct positive relationship between perceived discrimination and resting BP (e.g., Peters et al, 2007), but many do not (e.g., Brown, Matthews, Bromberger, & Chang, 2006;Clark, 2006;Matthews, Salomon, Kenyon, & Zhou, 2005;Peters, 2006). The latter studies either demonstrate that there is no relationship between perceived discrimination and blood pressure Peters, 2006), or that the relationship is moderated by a third variable (Clark, 2006;Matthews et al, 2005;Williams & Mohammed, 2009).…”

“…Other studies have investigated the relationship between perceived discrimination and physiological indicators of exposure to chronic stress (Clark, 2006;Peters, Benkert, Dinardo, & Templin, 2007;Ryan, Gee, & Lafl amme, 2006). Measures of cardiovascular function at rest, including BP, are thought to be related to chronic stress (McEwen, 2004).…”

Trust, Mistrust, Racial Identity and Patient Satisfaction in Urban African American Primary Care Patients of Nurse Practitioners

“…High levels of cultural mistrust inhibit the ability of European American providers to establish trusting primary‐care relationships (Benkert, Peters, Dinardo, & Tate, 2008) and indirectly affect assessment of satisfaction (Benkert et al, 2006). NPs have been able to overcome cultural mistrust and dissatisfaction with care among African Americans to achieve positive outcomes (Peters, Benkert, & Dinardo, 2007). This research is new; and no studies in primary care, including our own (Benkert et al, 2008), controlled for relationship length, gender or education despite known associations between higher levels of cultural mistrust among relatively less well‐educated African American males.…”

Discrimination and Chronic Kidney Disease among Caribbean Blacks: The Effects of Immigration and Social Status

“…In particular, investigations of blood pressure have been mixed. Some studies have found that individuals who face high levels of discrimination are more likely to have high blood pressure (Peters et al 2007) while other studies have found no association between discrimination and blood pressure (Davis et al 2005). One possible explanation for the current null finding is that discrimination is extremely prevalent among black Americans.…”