Emerging approaches to redressing multi-level racism and reproductive health disparities

Golden, Bethany; Asiodu, Ifeyinwa V.; Franck, Linda S.; Ofori-Parku, Celestine Yayra; Suárez-Baquero, Daniel Felipe Martín; Youngston, Tracy; McLemore, Monica R.

doi:10.1038/s41746-022-00718-2

Cited by 7 publications

(7 citation statements)

References 35 publications

(32 reference statements)

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“…This study adds to an ongoing discussion of how digital health transformation might contribute to existing health disparities . Disparities in technology use may emerge through differential access for patients with limited health literacy and members of racial and ethnic minority groups, as documented during the diffusion of patient portal use and telehealth .…”

Section: Discussionmentioning

confidence: 99%

Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations

et al. 2023

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ImportanceDigital health technologies may expand organizational capacity to treat opioid use disorder (OUD). However, it remains unclear whether these technologies serve as substitutes for or complements to traditional substance use disorder (SUD) treatment resources in health care organizations.ObjectiveTo characterize the use of patient-facing digital health technologies for OUD by US organizations with accountable care organization (ACO) contracts.Design, Setting, and ParticipantsThis cross-sectional study analyzed responses to the 2022 National Survey of Accountable Care Organizations (NSACO), collected between October 1, 2021, and June 30, 2022, from US organizations with Medicare and Medicaid ACO contracts. Data analysis was performed between December 15, 2022, and January 6, 2023.ExposuresTreatment resources for SUD (eg, an addiction medicine specialist, sufficient staff to treat SUD, medications for OUD, a specialty SUD treatment facility, a registry to identify patients with OUD, or a registry to track mental health for patients with OUD) and organizational characteristics (eg, organization type, Medicaid ACO contract).Main Outcomes and MeasuresThe main outcomes included survey-reported use of 3 categories of digital health technologies for OUD: remote mental health therapy and tracking, virtual peer recovery support programs, and digital recovery support for adjuvant cognitive behavior therapy (CBT). Statistical analysis was conducted using descriptive statistics and multivariable logistic regression models.ResultsOverall, 276 of 505 organizations responded to the NSACO (54.7% response rate), with a total of 304 respondents. Of these, 161 (53.1%) were from a hospital or health system, 74 (24.2%) were from a physician- or medical group–led organization, and 23 (7.8%) were from a safety-net organization. One-third of respondents (101 [33.5%]) reported that their organization used at least 1 of the 3 digital health technology categories, including remote mental health therapy and tracking (80 [26.5%]), virtual peer recovery support programs (46 [15.1%]), and digital recovery support for adjuvant CBT (27 [9.0%]). In an adjusted analysis, organizations with an addiction medicine specialist (average marginal effect [SE], 32.3 [4.7] percentage points; P &lt; .001) or a registry to track mental health (average marginal effect [SE], 27.2 [3.8] percentage points; P &lt; .001) were more likely to use at least 1 category of technology compared with otherwise similar organizations lacking these capabilities.Conclusions and RelevanceIn this cross-sectional study of 276 organizations with ACO contracts, organizations used patient-facing digital health technologies for OUD as complements to available SUD treatment capabilities rather than as substitutes for unavailable resources. Future studies should examine implementation facilitators to realize the potential of emerging technologies to support organizations facing health care practitioner shortages and other barriers to OUD treatment delivery.

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Section: Discussionmentioning

confidence: 99%

Provision of Digital Health Technologies for Opioid Use Disorder Treatment by US Health Care Organizations

et al. 2023

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“… 41 Comprehensive approaches inclusive of patient stakeholders are key to avoid proposing solutions that could inadvertently cause harm. 51 , 52 We can glean valuable information from these data, informing future obstetric quality measures and interventions. Antepartum anemia is modifiable, and addressing anemia through an equity lens has potential for closing disparity gaps in SMM.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity

Igbinosa,

Leonard,

Noelette

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. METHODS: We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. RESULTS: In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian–Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42–1.53 to approximated RR 1.27, 95% CI 1.22–1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5–25.0%), followed by Black (20.9%, 95% CI 18.1–23.4%) and Hispanic (20.9%, 95% CI 19.9–22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. CONCLUSION: Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian–Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.

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“…Multiple models have been proposed to address inequities at multiple levels of care, including factors at the level of healthcare delivery systems, research, individual providers, policymakers, and payers. 32 , 33 , 34 An example of one of these considerations is that many digital programs are exclusively in English, which may alienate patients who are non-English speakers from engaging fully with these programs. 32 , 34 One study from California of >84,000 patients found that patients with limited English proficiency had half the odds of telehealth use compared with proficient English speakers (4.8% vs 12.3%).…”

Section: Opportunities To Reduce Racial Inequities In Carementioning

confidence: 99%