Diabetes in the African-American Medicare Population: Morbidity, quality of care, and resource utilization

Chin, Marshall H.; Zhang, James; Merrell, Katie

doi:10.2337/diacare.21.7.1090

Cited by 148 publications

(85 citation statements)

References 6 publications

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“…2 Members of racial and ethnic minority groups are at increased risk for diabetes, 3, 4 with the rate for non-Hispanic African Americans and Mexican Americans almost twice that of non-Hispanic whites. 5–7 Lack of health insurance has been identified as an independent risk factor for poor outcomes in diabetes and is most prevalent in low income populations. 8,9 Behavioral risk factors for diabetes include poor quality diet, inadequate exercise, limited medication adherence, and depression, 10,11 all of which are common among poor, medically uninsured patients.…”

Section: Introductionmentioning

confidence: 99%

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Madden

Tomsik

Terchek

et al. 2011

Journal of the National Medical Association

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Objective To determine how medically uninsured patients with limited material resources successfully manage diabetes. Methods Clinicians at 5 safety net practices enrolled uninsured adult patients (N=26) with prior diagnosis of diabetes for 6 months or longer. Patients were interviewed about enabling factors, motivations, resources, and barriers. Chart reviews and clinician surveys supplemented interview data. Interview, survey, and chart review data were analyzed and findings were summarized. Results Two distinct groups of patients were investigated: 1) “successful,” defined as those with an HbA1c of ≤7% or a recent improvement of at least 2% (n=17); and 2) “unsuccessful,” defined as patients with HbA1c of ≥9% (n=9) without recent improvement. In comparison to unsuccessful patients, successful patients more often reported having friends or family with diabetes, sought information about the disease, used evidence-based self-management strategies, held an accurate perception of their own disease control, and experienced “turning point” events that motivated increased efforts in disease management. Conclusions Uninsured safety net patients who successfully managed diabetes learned from friends and family with diabetes and leveraged disease-related events into motivational turning points. It may be beneficial for clinicians to incorporate social learning and motivational enhancement into diabetes interventions to increase patients’ motivation for improved levels of self-management.

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Section: Introductionmentioning

confidence: 99%

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Madden

Tomsik

Terchek

et al. 2011

Journal of the National Medical Association

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“…2,[11][12][13][14][15] Many of these studies indicate that blacks and Hispanics have poorer health status than whites, 2,[11][12][13][14][15] are less likely to receive preventive care, 2,13-15 and experience higher death rates due to late diagnosis for certain diseases. [15][16][17][18][19] Cancer remains the second leading cause of death 20 in the United States, and for a number of malignancies, the minority population is disproportionately affected. [18][19][20] For example, cervical cancer rates rank among the highest in Hispanic women-who also rank among the lowest for receiving cancer screening and treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The frequency of hypertension, for example, is significantly higher in the black and Hispanic population 25,26 than among whites, and the incidence and burden of diabetes is much greater for minority populations than the white population. 21,[27][28][29] Diabetes-related mortality rates are higher for blacks and Hispanics than for whites, and diabetes-associated renal failure is 2.5 times higher in the black population than the Hispanic population. 28 It is worthy to note that urban safety net institutions in general have already addressed many of the issues which may contribute to these disparities.…”

Section: Introductionmentioning

confidence: 99%

Can America’s Urban Safety Net Systems be a Solution to Unequal Treatment?

2008

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Eliminating disparities in care for racial and ethnic minorities remains a challenge in achieving overall quality health care. One approach to resolving issues of inequity involves utilizing an urban safety-net system to address preventive and chronic care disparities. An analysis was undertaken at Denver Health (DH), an urban safety net which serves 150,000 patients annually, of which 78% are minorities and 50% uninsured. Medical charts for 4,795 randomly selected adult patients at ten DHassociated community health centers were reviewed between July 1999 and December 2001. Logistic regression was used to identify differences between racial/ethnic groups in cancer screening, blood pressure control, and diabetes management. No disparities in care were found, and in most instances, the quality of care met or exceeded available benchmarks, leading us to conclude that treatment in urban integrated safety net systems committed to caring for minority populations may represent one approach to reducing disparity.

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“…The role of race in the natural history and care of patients with diabetes has been a concern. AfricanAmericans have a greater prevalence of diabetes than Whites, as well as higher rates of complications, including retinopathy, nephropathy and amputation (Chin et al, 1998). This may lead to poor management of the disease itself, whether it is self-management or that provided by the health care practitioner (Larme et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Role of Insurance Coverage on Diabetes Preventive Care

Ashford

Walls

Brown

et al. 2017

European Journal of Environment and Public Health

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Minorities with diabetes are at an increased risk for low quality care and access to resource utilization, specifically health insurance coverage which often determines access to health care. The purpose of the study was to examine the relationship between insurance coverage and diabetes preventive care after adjusting for patient, physician care, and contextual characteristics. Study used data from the 2010 Medical Expenditure Panel Survey (MEPS). Patients represented a weighted total of 20,741,963 (n=2,182). The dependent variables included five measures of the recommended components of diabetes preventive care: receipt of A1C test, retinal eye exam, foot care, blood cholesterol check, and flu vaccination. The independent variables consisted of sociodemographic, physician care, and contextual characteristics. Receipt of each of the diabetes quality and preventive care measures was strongly associated with insurance coverage. Insured individuals were more likely to receive treatment than uninsured. However, the impact of insurance coverage was attenuated after adjusting for individual, physician care, and contextual characteristics. Physician care was the strongest predictor of diabetes preventive care. Our study identified the importance of health insurance coverage on diabetes preventive care. Physician care and contextual factors made a significant impact in receipt of diabetes preventive care.

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Diabetes in the African-American Medicare Population: Morbidity, quality of care, and resource utilization

Cited by 148 publications

References 6 publications

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Keys to Successful Diabetes Self-management for Uninsured Patients: Social Support, Observational Learning, and Turning Points: A Safety Net Providers' Strategic Alliance Study

Can America’s Urban Safety Net Systems be a Solution to Unequal Treatment?

Role of Insurance Coverage on Diabetes Preventive Care

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