Racial Disparity in Cardiac Decision Making

Ferguson, Jeffrey A.; Weinberger, Morris; Westmoreland, Glenda R.; Mamlin, Lorrie A.; Segar, Douglas S.; Greene, James Y.; Martin, Douglas K.; Tierney, William M.

doi:10.1001/archinte.158.13.1450

Cited by 60 publications

(31 citation statements)

References 27 publications

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“…17,36 Mistrust and perceived discrimination may contribute to differences in health care decision making and pursuit of care. 37 These perceptions may be justified, as studies have shown that faced with identical scenarios, physicians prescribe different diagnostic and treatment regimens to patients based on race. 13 Current problems with low Medicaid reimbursements and provider nonparticipation may play a role in minorities receiving less care in outpatient settings, as minorities depend in greater proportion on Medicaid.…”

Section: Discussionmentioning

confidence: 99%

Variation in participation in health care settings associated with race and ethnicity

Bliss¹,

Meyers

Phillips

et al. 2004

J GEN INTERN MED

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OBJECTIVE:To use the ecology model of health care to contrast participation of black, non-Hispanics (blacks); white, non-Hispanics (whites); and Hispanics of any race (Hispanics) in 5 health care settings and determine whether disparities between those individuals exist among places where they receive care. DESIGN:1996 Medical Expenditure Panel Survey data were used to estimate the number of black, white, and Hispanic people per 1,000 receiving health care in each setting. SETTING:Physicians' offices, outpatient clinics, hospital emergency departments, hospitals, and people's homes. MAIN MEASUREMENT:Number of people per 1,000 per month who had at least one contact in a health care setting. RESULTS: According to a recent report by the Centers for Disease Control (CDC), racial and ethnic minorities fare worse than nonminorities in several major health status categories, with little progress in reduction of disparities in most areas since 1990.1 For blacks and Hispanics, the incidence of infant and maternal mortality is higher, life expectancy is lower, and rates of some chronic diseases are greater than for whites. The overwhelming evidence of disparities in health and health care has sparked research comparing populations in terms of their characteristics or receipt of specific services. However, this perspective does not address the broader interactions of populations with the various settings of health care. Looking at populations and where they go when they decide to seek health care provides an "outside-in" view that helps explain where there is the greatest contribution to disparities.The Ecology of Medical Care by White et al. in 1961 19 and reprised by Green et al. in 2001 20 is an example of such a perspective. The ecology model depicts the number of people per 1,000 who access the health care system in an average month. The model does not report the quantity of services provided, focusing instead on individuals and whether they received any care in a health care setting. The methods of the ecology model do not permit conclusions about cause and effect, but they do elucidate who is getting care in those settings.

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Section: Discussionmentioning

confidence: 99%

Variation in participation in health care settings associated with race and ethnicity

Bliss¹,

Meyers

Phillips

et al. 2004

J GEN INTERN MED

View full text Add to dashboard Cite

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“…Further, there may be areas in which existing confirmed concepts can be enriched in the future. For example, involvement of family and friends in decision-making processes may be an important addition to the decision-making concept (Ferguson, Weinberger, Westmoreland, et al 1998;Riehman, Sly, Soler, et al 1998). Further modifications and final specification of the scales and framework should be based on additional validation studies.…”

Section: Discussionmentioning

confidence: 99%

Interpersonal Processes of Care in Diverse Populations

1999

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Persons of lower socioeconomic status and members of racial and ethnic minority groups experience poorer health and increased health risk factors. A framework of interpersonal processes of care specifies distinct components and incorporates the perspective of diverse racial and ethnic or socioeconomic groups. Its dimensions, each with several domains, are communication (general clarity, elicitation of and responsiveness to patient concerns, explanations, empowerment), decision making (responsiveness to patient preferences, consideration of ability and desire to comply), and interpersonal style (friendliness, respectfulness, discrimination, cultural sensitivity, support). All the domains, except cultural sensitivity, were validated through a survey of 603 ethnically diverse, low‐income adults. Confirmation of the framework's usefulness should enable researchers to explore how interpersonal processes might account for observed ethnic and social class differences in health care and health.

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“…Little is known about factors that influence patient decision-making in ischemic heart disease, as well as whether racial groups differ in regard to these factors. To advance knowledge in these areas, Ferguson and colleagues 88 conducted a study using 15 focus groups with black and white patients who had received treatment for ischemic heart disease in 1 of 2 university-affiliated hospital emergency …”

Section: Equitymentioning

confidence: 99%

Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research

2009

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O utcomes research examines the effects of medical care interventions and policies on the health outcomes of individuals and society. 1 Investigators conducting outcomes research seek to inform the development of clinical practice guidelines, to evaluate the quality of medical care, and to foster effective interventions to improve the quality of care. 2 Outcomes research has traditionally used quantitative sciences to examine the utilization, cost, and clinical effectiveness of medical care through randomized and nonrandomized experimental designs. Quantitative methods are not as well suited to measure other complex aspects of the healthcare delivery system, such as organizational change, clinical leadership in implementing evidence-based guidelines, and patient perceptions of quality of care, which are also critical issues in outcomes research. [3][4][5][6][7] These more nuanced aspects of healthcare delivery may be most appropriately examined with qualitative research methods. 8 -10 Qualitative approaches are becoming more common in clinical medicine and health services research. 5,[11][12][13][14][15] Federal encouragement of qualitative research is regularly reflected in funding program announcements issued by the National Institutes of Health. 16 For more than a decade, federal agencies and foundations such as the National Science Foundation have demonstrated a commitment to supporting qualitative research through funding scientific conferences, workshops, and monographs on this field of inquiry. [17][18][19][20] Despite this steady growth in qualitative research, outcomes investigators in cardiology have relatively little guidance on when and how best to implement these methods in their investigations.The purpose of the present report is to introduce qualitative methods as providing unique and critical contributions to outcomes research. This report will describe the situations in which qualitative approaches are most helpful; summarize the primary principles and practices in study design, sampling, data collection, and data analysis for qualitative studies; present representative examples of cardiovascular outcomes research that uses qualitative methods; and synthesize current standards for ensuring rigor and enhancing credibility of qualitative research. Defining Qualitative ResearchQualitative research is a form of scientific inquiry that spans different disciplines, fields, and subject matter and comprises many varied approaches. 21 Qualitative methods can be used to understand complex social processes, to capture essential aspects of a phenomenon from the perspective of study participants, 5 and to uncover beliefs, values, and motivations that underlie individual health behaviors. [22][23][24] Such research can also illuminate aspects of organizational context and healthcare delivery that influence organizational performance and quality of care. 10,25 Qualitative studies are often exploratory in nature and seek to generate novel insights 9,23,26,27 using inductive (starting with observations and dev...

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Racial Disparity in Cardiac Decision Making

Cited by 60 publications

References 27 publications

Variation in participation in health care settings associated with race and ethnicity

Variation in participation in health care settings associated with race and ethnicity

Interpersonal Processes of Care in Diverse Populations

Qualitative and Mixed Methods Provide Unique Contributions to Outcomes Research

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