49 results on '"Hicks LS"'
Search Results
2. Racial and gender disparities in implantable cardioverter-defibrillator placement: are they due to overuse or underuse?
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Cook NL, Orav EJ, Liang CL, Guadagnoli E, and Hicks LS
- Abstract
Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men, to receive an ICD (adjusted OR = 0.48; 95% CI = 0.34-0.67). In this cohort, these differences appear related to overutilization among men and Whites who are discordant with ICD placement criteria in addition to underutilization among Blacks concordant with placement criteria. [ABSTRACT FROM AUTHOR]
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- 2011
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3. Hospitalists and the quality of care in hospitals.
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López L, Hicks LS, Cohen AP, McKean S, and Weissman JS
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- 2009
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4. Differences in specialist consultations for cardiovascular disease by race, ethnicity, gender, insurance status, and site of primary care.
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Cook NL, Ayanian JZ, Orav EJ, and Hicks LS
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- 2009
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5. Accuracy of ICD-9 coding for Clostridium difficile infections: a retrospective cohort.
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Scheurer DB, Hicks LS, Cook EF, and Schnipper JL
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Clostridium difficile (C. diff) is a major nosocomial problem. Epidemiological surveillance of the disease can be accomplished by microbiological or administrative data. Microbiological tracking is problematic since it does not always translate into clinical disease, and it is not always available. Tracking by administrative data is attractive, but ICD-9 code accuracy for C. diff is unknown. By using a large administrative database of hospitalized patients with C. diff (by ICD-9 code or cytotoxic assay), this study found that the sensitivity, specificity, positive, and negative predictive values of ICD-9 coding were 71%, 99%, 87%, and 96% respectively (using micro data as the gold standard). When only using symptomatic patients the sensitivity increased to 82% and when only using symptomatic patients whose test results were available at discharge, the sensitivity increased to 88%. C. diff ICD-9 codes closely approximate true C. diff infection, especially in symptomatic patients whose test results are available at the time of discharge, and can therefore be used as a reasonable alternative to microbiological data for tracking purposes. [ABSTRACT FROM AUTHOR]
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- 2007
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6. Improving the management of chronic disease at community health centers.
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Landon BE, Hicks LS, O'Malley AJ, Lieu TA, Keegan T, McNeil BJ, and Guadagnoli E
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- 2007
7. The quality of chronic disease care in U.S. community health centers: CHC care for three chronic diseases compares favorably with such care in other settings, except for care of the uninsured.
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Hicks LS, O'Malley AJ, Lieu TA, Keegan T, Cook NL, McNeil BJ, Landon BE, and Guadagnoli E
- Abstract
Community health centers (CHCs) are responsible for providing care for more than fifteen million Americans, many of whom are members of groups who have been documented to receive low-quality care. This study examines the quality of care for patients with chronic disease in a nationally representative sample of federally funded CHCs. Fewer than half of eligible patients received appropriate care for the majority of indicators measured, and uninsured patients received poorer care than insured patients. Although the quality of chronic disease care in CHCs compares favorably with that of care received in other settings, gaps in quality were observed for the uninsured. [ABSTRACT FROM AUTHOR]
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- 2006
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8. Improving the management of chronic disease.
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Sadof MD, Rosenbaum S, Smolkin MT, Selby JV, Mangione CM, Gerzoff RB, Landon BE, Hicks LS, and Guadagnoli E
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- 2007
9. A Population Health Proposal for Increasing Breast Cancer Screening to Reduce Racial Disparities in Breast Cancer: Getting the Village Back Together.
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Siegel SD, Rowland JP, Leonard DJ, Katurakes N, Bittner-Fagan H, Hoffman M, Hall-McBride R, Hicks LS, and Petrelli NJ
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- Humans, United States epidemiology, Female, Early Detection of Cancer, Racial Groups, Ethnicity, Healthcare Disparities, Breast Neoplasms diagnosis
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- 2024
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10. Low-cost insulin for socially at-risk patients: evidence for effectiveness.
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Mapp AM, Hicks LS, and Goldstein JN
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- Adult, Humans, Insulin therapeutic use, Nutrition Surveys, Retrospective Studies, Diabetes Mellitus, Type 2, Hypoglycemic Agents therapeutic use
- Abstract
Objectives: The price of analogue insulin has increased dramatically, making it unaffordable for many patients and insurance carriers. By contrast, human synthetic insulins are available at a fraction of the cost. The objective of this study was to examine whether patients with financial constraints were more likely to use low-cost human insulins compared with higher-cost analogue insulins and to determine whether outcomes differ between users of each type of insulin., Study Design: Retrospective cohort study., Methods: Analysis of 4 cycles of the National Health and Nutrition Examination Survey was performed. Adults with diabetes who reported use of insulin were included. The primary outcome was use of human insulin or analogue insulin. The dependent variable was self-reported financial constraints, a composite variable. Secondary analysis examined the association between use of human vs analogue insulin and patient outcomes., Results: Of 22,263 eligible respondents, 698 (3.1%) reported use of insulin and the type of insulin used, representing 485,228 patients nationally. Patients with 1 or more financial risk factors were more likely to use human insulin compared with patients without any financial risk factors (88.5% vs 76.7%; P = .014). There was no association between use of human vs analogue insulin on diabetic or other patient outcomes among patients regardless of financial risk., Conclusions: Patients with financial risk factors may be more likely to use low-cost human synthetic insulins compared with insulin analogues. Outcomes were similar, even when stratified by financial risk.
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- 2021
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11. Predictors and Outcomes of Patient Knowledge of Plan of Care in Hospital Medicine: A Quality Improvement Study.
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Bhamidipati VS, Hicks LS, Caplan R, Ingraham B, Rn PM, and Robinson EJ
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- Humans, Length of Stay, Patient Readmission, Quality Improvement, Hospital Medicine, Hospitalists, Teaching Rounds
- Abstract
Background: Patient understanding of plan of care is associated with positive outcomes in ambulatory settings. In hospital medicine settings, patient-physician agreement on plan of care (concordance) has been limited and difficult to improve. This study examined the impact of adding a hospitalist to interdisciplinary rounds (IDR) on physician-patient-nurse concordance and the relationship between concordance and outcomes., Methods: IDR were conducted by core teams made up of unit-based nurses, a case manager, and a pharmacist. Over time, with cohorting, hospitalists were included in IDR (hospitalist IDR) for some patients assigned to unit-based hospitalists. In developing hospitalist IDR, the researchers emphasized using an IDR checklist, including a patient communication plan. Patient-nurse-physician interviews were used to assess concordance in the domains of diagnosis, tests and procedures, and expected discharge date. Using two-hospitalist review, agreement was rated as none, partial, or complete, and a total concordance score was calculated for each patient in both IDR groups. Multivariate analysis was used to examine the relationship between concordance, IDR type, patient factors, and utilization outcomes., Results: For 658 patients, the mean concordance score was 11.71 out of a possible 18. There was no difference in concordance between hospitalist and core IDR groups (11.68 vs. 11.84, p = 0.7). Higher total concordance score was associated with lower lengths of stay (p < 0.001) and readmission rates (p = 0.001). Total concordance had a negative association with patient age (p = 0.04)., Conclusion: Concordance did not change with IDR type. Higher concordance appears to be related to positive utilization outcomes. Future studies are needed to evaluate potential interventions to improve concordance., (Copyright © 2020 The Joint Commission. Published by Elsevier Inc. All rights reserved.)
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- 2021
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12. Impact of care coordination based on insurance and zip code.
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Goldstein JN, Shinwari M, Kolm P, Elliott DJ, Weintraub WS, and Hicks LS
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- Aged, Delaware, Female, Humans, Male, Medicaid statistics & numerical data, Medicare statistics & numerical data, Middle Aged, Patient Readmission statistics & numerical data, Retrospective Studies, Social Class, United States, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Patient Care Management statistics & numerical data, Percutaneous Coronary Intervention statistics & numerical data, Residence Characteristics statistics & numerical data
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Objectives: To examine whether a care transitions program, Bridges, differentially reduced rehospitalizations among patients who underwent percutaneous coronary intervention (PCI) based on insurance status and zip code poverty level., Study Design: Retrospective observational cohort., Methods: We examined data from a single health system in Delaware, collected as part of a care transitions program for patients who underwent PCI from 2012 to 2015 compared with an unmatched historical control cohort from 2010 to 2011. Socioeconomic status was assessed by insurance status and zip code-level poverty data. Patients were divided into tertiles based on the proportion of their zip code of residence living under 100% of the federal poverty level. Rehospitalization rates were analyzed by negative binomial regression and included interaction terms to examine differential effects of Bridges by insurance and poverty level., Results: There were 4638 patients representing 5710 hospitalizations: 3212 in the historical control and 2498 in the Bridges cohort. Among patients with Medicaid who received the Bridges intervention, those living in the wealthiest zip codes were 15.5% less likely to be rehospitalized than patients with Medicare and 9.4% less likely than patients with commercial insurance (P = .04). However, patients with Medicaid who lived in the poorest zip codes and those with dual Medicare/Medicaid status had higher rates of rehospitalization post intervention., Conclusions: The Bridges intervention was associated with improved rehospitalization rates for Medicaid patients compared with those with Medicare or commercial insurance within Delaware's wealthier communities. Care transitions programs may differentially affect Medicaid patients based on the wealth of the communities in which they reside.
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- 2019
13. Frequency of Sale and Reasons for Purchase of Over-the-Counter Insulin in the United States.
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Goldstein JN, Patel RM, Bland K, and Hicks LS
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- Cost Sharing, Humans, Surveys and Questionnaires, United States, Commerce statistics & numerical data, Diabetes Mellitus drug therapy, Health Expenditures, Hypoglycemic Agents, Insulin, Medically Uninsured, Nonprescription Drugs, Pharmacies
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- 2019
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14. "Implications of cost-sharing for observation care among Medicare beneficiaries: a pilot survey".
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Goldstein JN, Schwartz JS, McGraw P, and Hicks LS
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- Aged, Female, Health Expenditures, Health Services Accessibility, Humans, Male, Pilot Projects, Surveys and Questionnaires, United States, Clinical Observation Units economics, Cost Sharing, Medicare
- Abstract
Background: Medicare beneficiaries hospitalized under observation status have significant cost-sharing responsibilities under Medicare Part B. Prior work has demonstrated an association between increased cost-sharing and health care rationing among low-income Medicare beneficiaries. The objective of this study was to explore the potential impact of observation cost-sharing on future medical decision making of Medicare beneficiaries., Methods: Single-center pilot cohort study. A convenience sample of Medicare beneficiaries hospitalized under observation status care was surveyed., Results: Out of 144 respondents, low-income beneficiaries were more likely to be concerned about the cost of their observation stay than higher-income respondents (70.7% vs29.3%, p = 0.015). If hospitalized under observation status again, there was a trend among low-income beneficiaries to request completion of their workup outside of the hospital (56.3% vs 43.8%), and to consider leaving against medical advice (AMA) (100% vs 0%), though these trends were not statistically significant (p = 0.30)., Conclusion: The results of this pilot study suggest that low-income Medicare beneficiaries hospitalized under observation status have greater concerns about their cost-sharing obligations than their higher income peers. Cost-sharing for observation care may have unintended consequences on utilization for low-income beneficiaries. Future studies should examine this potential relationship on a larger scale.
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- 2019
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15. The Reply.
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Goldstein JN, Zhang Z, Schwartz JS, and Hicks LS
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- Medicare, United States, Financial Statements, Poverty
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- 2018
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16. Observation Status, Poverty, and High Financial Liability Among Medicare Beneficiaries.
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Goldstein JN, Zhang Z, Schwartz JS, and Hicks LS
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- Emergency Service, Hospital, Female, Humans, Inpatients, Male, Retrospective Studies, United States, Health Expenditures, Medicare, Observation, Poverty
- Abstract
Background: Medicare beneficiaries hospitalized under observation status are subject to cost-sharing with no spending limit under Medicare Part B. Because low-income status is associated with increased hospital use, there is concern that such beneficiaries may be at increased risk for high use and out-of-pocket costs related to observation care. Our objective was to determine whether low-income Medicare beneficiaries are at risk for high use and high financial liability for observation care compared with higher-income beneficiaries., Methods: We performed a retrospective, observational analysis of Medicare Part B claims and US Census Bureau data from 2013. Medicare beneficiaries with Part A and B coverage for the full calendar year, with 1 or more observation stay(s), were included in the study. Beneficiaries were divided into quartiles representing poverty level. The associations between poverty quartile and high use of observation care and between poverty quartile and high financial liability for observation care were evaluated., Results: After multivariate adjustment, the risk of high use was higher for beneficiaries in the poor (Quartile 3) and poorest (Quartile 4) quartiles compared with those in the wealthiest quartile (Quartile 1) (adjusted odds ratio [AOR], 1.21; 95% confidence interval [CI], 1.13-1.31; AOR, 1.24; 95% CI, 1.16-1.33). The risk of high financial liability was higher in every poverty quartile compared with the wealthiest and peaked in Quartile 3, which represented the poor but not the poorest beneficiaries (AOR, 1.17; 95% CI, 1.10-1.24)., Conclusions: Poverty predicts high use of observation care. The poor or near poor may be at highest risk for high liability., (Copyright © 2018 Elsevier Inc. All rights reserved.)
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- 2018
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17. The Unmet Need for Postacute Rehabilitation Among Medicare Observation Patients: A Single-Center Study.
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Goldstein JN, Schwartz JS, McGraw P, Banks TL, and Hicks LS
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- Acute Disease, Adolescent, Adult, Aged, Electronic Health Records trends, Female, Humans, Length of Stay trends, Male, Middle Aged, Rehabilitation methods, United States epidemiology, Young Adult, Health Services Needs and Demand trends, Hospitals, Community trends, Medicare trends, Patient Discharge trends, Rehabilitation trends, Tertiary Care Centers trends
- Abstract
Background: Medicare beneficiaries admitted under observation status must pay for postacute inpatient rehabilitation (PAIR) services, out of pocket, at potentially prohibitive costs., Objective: To determine if there is an unmet need for PAIR among Medicare observation patients and if this care is associated with longer hospital stay and increased rehospitalization., Design/setting: Observational study using electronic medical record and administrative data from a regional health system., Patients: 1323 community-dwelling Medicare patients admitted under observation status., Measurements: Summary statistics were calculated for demographic and administrative variables. Physical therapy (PT) and case management recommendations for a representative sample of 386 medical records were reviewed regarding need for PAIR services. Linear regression was used to measure the association between PT recommendation and hospital length of stay, adjusting for ICD-9 (International Classification of Diseases, Ninth Revision) diagnosis, age, sex, and provider. Chi-square test was used to determine the association between PT recommendation and 30-day hospital revisit., Results: Of the 1323 study patients, 11 (0.83%) were discharged to PAIR facilities. However, 17 (4.4%) of the 386 patients whose charts were reviewed received a recommendation for this care. Adjusted mean hospital stay was longer (P ⟨ 0.001) for patients recommended for rehabilitation (75.9 h) than for patients with no PT needs (46.8 h). In addition, the 30-day hospital revisit rate was higher (P = 0.037) for the patients who had been recommended for rehabilitation (52.9%, 9/17) than for those who had not (25.4%, 30/118)., Conclusions: Medicare observation patients' potential need for PAIR services is 5- to 6-fold higher than their use of these services. Observation patients recommended for this care may have worse outcomes. Journal of Hospital Medicine 2017;12:168-172., (© 2017 Society of Hospital Medicine)
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- 2017
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18. Is the Care Transitions Measure Associated with Readmission Risk? Analysis from a Single Academic Center.
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Goldstein JN, Hicks LS, Kolm P, Weintraub WS, and Elliott DJ
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- Academic Medical Centers, Aged, Chi-Square Distribution, Female, Humans, Logistic Models, Male, Middle Aged, Patient Readmission statistics & numerical data, Percutaneous Coronary Intervention statistics & numerical data, Prospective Studies, Quality Improvement, Risk Assessment, Single-Blind Method, Surveys and Questionnaires, Patient Discharge statistics & numerical data, Patient Readmission economics, Patient Transfer economics
- Abstract
Background: It is widely hypothesized that improvement in transitions of care will reduce unplanned hospital readmissions. However, the association between the Care Transitions Measure, the national quality metric for transitions of care and readmission risk, has not been established., Objective: We aimed to determine the association between the Care Transition Measure and readmission., Design: This was a single-center, prospective cohort study., Participants: Convenience sample of 2,963 patients enrolled in the "Bridging the Divides" program, a longitudinal care management program for patients with coronary revascularization, from 2013 to 2014. Of these, 1594 (54 %) patients completed a post-discharge Care Transition Measure questionnaire., Intervention: Care Transition Measure scores were collected by trained research staff blinded to study hypothesis, by telephone, within 30 days of discharge. Higher Care Transition Measure scores reflect a higher quality transition of care., Main Measures: 30-day readmission was measured., Key Results: Of the1594 patients that completed the Care Transition Measure survey, 1216 (76 %) received percutaneous coronary intervention and 378 (24 %) received coronary artery bypass grafting. Mean Care Transition Measure scores were significantly lower among patients who had a prior admission (77.2 vs. 82.1, p < 0.001) and those with ≥ 5 comorbidities (77 vs. 82.6 vs. 81.6, p < 0.001). Mean scores were significantly lower among patients who were readmitted within the percutaneous coronary intervention subgroup (73 vs. 80.9, p < 0.001) and the total study population (74.6 vs. 81.1, p < 0.001) compared to those who were not readmitted. This was not the case in the coronary artery bypass grafting subgroup (78.5 vs. 81.7, p = 0.29). After multivariable adjustment, every ten-point increase in the Care Transition Measure score was associated with a 14 % reduction in readmission risk (adjusted odds ratio 0.86, 95 % CI 0.78-0.95)., Conclusions: The Care Transition Measure is strongly associated with readmissions, which strengthens its validity. However, its association with patient variables linked with readmission and its inconsistent association with readmission across clinical groups raises concerns that scores may be influenced by patient characteristics., Competing Interests: Compliance with ethical standards Funders The project described was supported by Grant Number 1C1CMS331027 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The content of this presentation are solely the responsibility of the authors and have not been approved by the Department of Health and Human Services, Centers for Medicare & Medicaid Services. Dr. Goldstein and Dr. Hicks are supported by and Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number U54-GM104941 (PI: Binder-Macleod). The above funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Conflict of Interest The authors declare that they do not have a conflict of interest.
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- 2016
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19. Health Center Professional Programs and Primary Care Workforce.
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Aysola J, Groves D, and Hicks LS
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Background: Current policy promotes health center professional training and pipeline programs as solutions to bolster primary care workforce in shortage areas, despite the paucity of evidence., Methods: We analyzed data from US health centers we surveyed from March to June 2010, merged with federal health center data, to estimate associations between health center training and pipeline programs and provider recruitment and retention., Results: Of the 976 surveyed, 391 health centers responded. Health centers with career ladder programs compared to those without had higher adjusted rates of no/minimal difficulty in recruitment of primary care providers. (17.6% vs. 10.6%; p=.01) and close to double the adjusted rates of reporting no/minimal difficulty in retention of primary care providers (39.4% vs. 21.2%; p=.0001)., Discussion: There remains a need for further evaluation of health professional programs in order to expand models, such as career ladder programs, that demonstrate effectiveness in improving the primary care workforce in shortage areas.
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- 2015
20. Vitamin D Deficiency Treatment Patterns in Academic Urban Medical Center.
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Chandler PD, Giovannucci EL, Williams MA, LeBoff MS, Bates DW, and Hicks LS
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Objective: Assess racial/ethnic and sex differences in treatment of vitamin D deficiency with high dose ergocalciferol ('vitamin D2') or other forms of vitamin D in a northeastern U.S. ambulatory clinic of an academic urban medical center., Study Design: Cross-sectional observational review of electronic medication prescribing records of patients with 25-hydroxyvitamin D (25OHD) deficiency (25OHD < 20 ng/ml) from 2004-2008., Methods: Using multivariable logistic regression adjusting for patients' demographics, and Elixhauser comorbidity score, we examined the association of sex and race/ethnicity with prescription for at least one dose of vitamin D., Results: Among 2,140 patients without renal disease and tested for 25OHD deficiency (25OHD < 20 ng/ml), 66.2% received no vitamin D prescription for vitamin D deficiency. Blacks and Hispanics received vitamin D prescriptions at a higher frequency than whites, 37.8% 38.4% and 30.9%, respectively, p=0.003. The vitamin D prescription rate for women versus men was 26.3% and 7.5%, respectively, p=0.04. In a fully adjusted model, no difference in prescription likelihood for blacks and whites [OR=1.18 95% CI, 0.88-1.58; p=0.29] or Hispanics and whites was noted [OR=1.01 95% CI, 0.70-1.45;p=0.73]. Similarly, fully adjusted model showed no difference in prescription likelihood for females and males [OR=1.23 95% CI, 0.93-1.63; p=0.12]., Conclusions: Among primary care patients with vitamin D deficiency, vitamin D supplementation was low and white patients were less likely to receive vitamin D treatment than blacks or Hispanics. Interventions to correct the high prevalence of vitamin D deficiency should address the markedly low rate of vitamin D prescribing when 25OHD levels are measured.
- Published
- 2014
21. Association of recent incarceration with traumatic injury, substance use-related health consequences, and health care utilization.
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Redmond N, Hicks LS, Cheng DM, Allensworth-Davies D, Winter MR, Samet JH, and Saitz R
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- Adult, Attitude to Health, Cohort Studies, Female, Humans, Male, Middle Aged, Multivariate Analysis, United States epidemiology, Patient Acceptance of Health Care statistics & numerical data, Prisoners statistics & numerical data, Substance-Related Disorders epidemiology, Wounds and Injuries epidemiology
- Abstract
Objective: The higher risk of death among recently released inmates relative to the general population may be because of the higher prevalence of substance dependence among inmates or an independent effect of incarceration. We explored the effects of recent incarceration on health outcomes that may be intermediate markers for mortality., Methods: Longitudinal multivariable regression analyses were conducted on interview data (baseline, 3-, 6-, and 12-month follow-up) from alcohol- and/or drug-dependent individuals (n = 553) participating in a randomized clinical trial to test the effectiveness of chronic disease management for substance dependence in primary care. The main independent variable was recent incarceration (spending ≥1 night in jail or prison in the past 3 months). The 3 main outcomes of this study were any traumatic injury, substance use-related health consequences, and health care utilization--defined as hospitalization (excluding addiction treatment or detoxification) and/or emergency department visit., Results: Recent incarceration was not significantly associated with traumatic injury (adjusted odds ratio [AOR] = 0.98; 95% confidence interval [CI]: 0.65-1.49) or health care utilization (AOR = 0.88; 95% CI: 0.64-1.20). However, recent incarceration was associated with higher odds for substance use-related health consequences (AOR = 1.42; 95% CI: 1.02-1.98)., Conclusions: Among people with alcohol and/or drug dependence, recent incarceration was significantly associated with substance use-related health consequences but not injury or health care utilization after adjustment for covariates. These findings suggest that substance use-related health consequences may be part of the explanation for the increased risk of death faced by former inmates.
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- 2014
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22. Assessing the need for improved access to rheumatology care: a survey of Massachusetts community health center medical directors.
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Feldman CH, Hicks LS, Norton TL, Freeman E, and Solomon DH
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- Antirheumatic Agents therapeutic use, Data Collection, Humans, Immunosuppressive Agents therapeutic use, Insurance, Health statistics & numerical data, Massachusetts epidemiology, Medicare statistics & numerical data, Rheumatic Diseases epidemiology, Surveys and Questionnaires, United States, Community Health Centers statistics & numerical data, Health Services Accessibility trends, Physician Executives statistics & numerical data, Rheumatic Diseases drug therapy
- Abstract
Objective: Access to rheumatology care can expedite diagnosis and treatment of rheumatic diseases and reduce disparities. We surveyed community health center (CHC) medical directors to evaluate rheumatology care in underserved areas and potential strategies for improvement., Methods: We identified 77 Massachusetts CHCs that provide adult medical services and sent a 40-item survey to their physician medical directors. Survey questions assessed the centers' prevalence of rheumatic diseases, prescribing practices of immunosuppressive medications, and possible interventions to improve care. We compared CHC characteristics and rheumatology-specific items and then stratified our data by the response to whether improved access to rheumatology care was needed. Qualitative data were analyzed thematically., Results: Thirty-six CHC physician medical directors returned surveys (47% response rate). Fifty-five percent indicated a need for better access to rheumatology care. Eighty-six percent of CHC physicians would not start a patient with rheumatoid arthritis on a disease-modifying antirheumatic drug; 94% would not start a patient with systemic lupus erythematosus on an immunosuppressant. When we compared CHCs that reported needing better access to rheumatology care to those that did not, the former described a significantly greater percentage of patients with private insurance or Medicaid who required outside rheumatology referrals (P < 0.05). Language differences and insurance status were highlighted as barriers to obtaining rheumatology care. Sixteen directors (57%) ranked the patient navigator-a layperson to assist with care coordination-as their first-choice intervention., Conclusions: Community health center medical directors expressed a need for better access to rheumatology services. A patient navigator for rheumatic diseases was proposed to help improve care and reduce health disparities.
- Published
- 2013
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23. Impact of hospital teaching intensity on quality of care and patient outcomes.
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Mueller SK, Lipsitz S, and Hicks LS
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- Cross-Sectional Studies, Databases, Factual, Heart Failure drug therapy, Heart Failure mortality, Hospital Mortality, Humans, Linear Models, Myocardial Infarction drug therapy, Myocardial Infarction mortality, Pneumonia drug therapy, Pneumonia mortality, United States epidemiology, Hospitals, Teaching, Outcome Assessment, Health Care, Quality of Health Care standards
- Abstract
Background: Proposed changes to financing of teaching hospitals and new quality-based performance incentives may differentially impact the financial health of teaching and safety-net institutions. Few data have examined the potential impact of these financial changes on teaching institutions., Objectives: To determine the association of hospital teaching intensity with processes and outcomes of care for the most common inpatient diagnoses in the United States., Research Design: Cross-sectional analysis of the 2008 Hospital Quality Alliance and 2007 American Hospital Association databases, adjusted for hospital characteristics., Subjects: A total of 2418 hospitals distributed across the country with available data on teaching intensity (resident-to-bed ratio), quality-of-care process measures, and risk-adjusted readmission and mortality rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia., Measures: Hospital-level quality-of-care process indicators and 30-day risk-adjusted readmission and mortality rates for AMI, CHF, and pneumonia., Results: Multivariable analysis demonstrates that all hospitals perform uniformly well on quality-of-care process measures for AMI, CHF, and pneumonia. However, when compared with nonteaching hospitals, increasing hospital teaching intensity is significantly associated with improved risk-adjusted mortality for AMI and CHF, but higher risk-adjusted readmission rates for all 3 conditions. Among high teaching intensity hospitals, those with larger Medicaid populations (safety-net institutions) had particularly high readmission rates for AMI and CHF., Conclusions: In this nationally representative evaluation, we found significant variation in performance on risk-adjusted mortality and readmission rates, and differences in readmission rates based on safety-net status. Our findings suggest that high teaching intensity and safety-net institutions may be disproportionately affected by upcoming changes in hospital payment models.
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- 2013
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24. Association of acculturation and country of origin with self-reported hypertension and diabetes in a heterogeneous Hispanic population.
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Rodriguez F, Hicks LS, and López L
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- Adult, Aged, California epidemiology, Central America ethnology, Confidence Intervals, Diabetes Mellitus ethnology, Female, Health Surveys, Humans, Hypertension ethnology, Logistic Models, Male, Mexico ethnology, Middle Aged, Odds Ratio, South America ethnology, Young Adult, Acculturation, Diabetes Mellitus epidemiology, Hypertension epidemiology
- Abstract
Background: Hispanics are the fasting growing population in the U.S. and disproportionately suffer from chronic diseases such as hypertension and diabetes. Little is known about the complex interplay between acculturation and chronic disease prevalence in the growing and increasingly diverse Hispanic population. We explored the association between diabetes and hypertension prevalence among distinct U.S. Hispanic subgroups by country of origin and by degree of acculturation., Methods: We examined the adult participants in the 2001, 2003, 2005, and 2007 California Health Interview Survey (CHIS). Using weighted logistic regression stratified by nativity, we measured the association between country of origin and self-reported hypertension and diabetes adjusting for participants' demographics, insurance status, socio-economic status and degree of acculturation measured by citizenship, English language proficiency and the number of years of residence in the U.S., Results: There were 33,633 self-identified Hispanics (foreign-born: 19,988; U.S.-born: 13,645). After multivariable adjustment, we found significant heterogeneity in self-reported hypertension and diabetes prevalence among Hispanic subgroups. Increasing years of U.S. residence was associated with increased disease prevalence. Among all foreign-born subgroups, only Mexicans reported lower odds of hypertension after adjustment for socioeconomic and acculturation factors. Both U.S.-born and foreign-born Mexicans had higher rates of diabetes as compared to non-Hispanic whites., Conclusions: We found significant heterogeneity among Hispanics in self-reported rates of hypertension and diabetes by acculturation and country of origin. Our findings highlight the importance of disaggregation of Hispanics by country of origin and acculturation factors whenever possible.
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- 2012
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25. A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups.
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De las Nueces D, Hacker K, DiGirolamo A, and Hicks LS
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- Health Behavior, Humans, Outcome and Process Assessment, Health Care, Clinical Trials as Topic methods, Community-Based Participatory Research organization & administration, Ethnicity, Racial Groups, Research Design
- Abstract
Objective: To examine the effectiveness of current community-based participatory research (CBPR) clinical trials involving racial and ethnic minorities., Data Source: All published peer-reviewed CBPR intervention articles in PubMed and CINAHL databases from January 2003 to May 2010., Study Design: We performed a systematic literature review., Data Collection/extraction Methods: Data were extracted on each study's characteristics, community involvement in research, subject recruitment and retention, and intervention effects., Principle Findings: We found 19 articles meeting inclusion criteria. Of these, 14 were published from 2007 to 2010. Articles described some measures of community participation in research with great variability. Although CBPR trials examined a wide range of behavioral and clinical outcomes, such trials had very high success rates in recruiting and retaining minority participants and achieving significant intervention effects., Conclusions: Significant publication gaps remain between CBPR and other interventional research methods. CBPR may be effective in increasing participation of racial and ethnic minority subjects in research and may be a powerful tool in testing the generalizability of effective interventions among these populations. CBPR holds promise as an approach that may contribute greatly to the study of health care delivery to disadvantaged populations., (© Health Research and Educational Trust.)
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- 2012
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26. Cardiovascular disease and risk in primary care settings in the United States.
- Author
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Ndumele CD, Baer HJ, Shaykevich S, Lipsitz SR, and Hicks LS
- Subjects
- Adult, Age Distribution, Aged, Ambulatory Care Facilities statistics & numerical data, Cross-Sectional Studies, Diabetes Mellitus epidemiology, Emergency Service, Hospital statistics & numerical data, Female, Health Knowledge, Attitudes, Practice, Health Surveys, Humans, Male, Medically Uninsured statistics & numerical data, Middle Aged, Minority Groups statistics & numerical data, Multivariate Analysis, Outpatient Clinics, Hospital statistics & numerical data, United States epidemiology, Young Adult, Cardiovascular Diseases epidemiology, Primary Health Care statistics & numerical data
- Abstract
Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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27. Health disparities and the criminal justice system: an agenda for further research and action.
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Binswanger IA, Redmond N, Steiner JF, and Hicks LS
- Subjects
- Humans, United States, Health Status Disparities, Prisons, Research
- Abstract
Although racial and ethnic minorities are more likely to be involved with the criminal justice system than whites in the U.S.A., critical scientific gaps exist in our understanding of the relationship between the criminal justice system and the persistence of racial/ethnic health disparities. Individuals engaged with the criminal justice system are at risk for poor health outcomes. Furthermore, criminal justice involvement may have direct or indirect effects on health and health care. Racial/ethnic health disparities may be exacerbated or mitigated at several stages of the criminal justice system. Understanding and addressing the health of individuals involved in the criminal justice system is one component of a comprehensive strategy to reduce population health disparities and improve the health of our urban communities.
- Published
- 2012
- Full Text
- View/download PDF
28. Impact of electronic health records on racial and ethnic disparities in blood pressure control at US primary care visits.
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Samal L, Lipsitz SR, and Hicks LS
- Subjects
- Female, Humans, Male, Middle Aged, United States, Decision Support Systems, Clinical, Electronic Health Records, Healthcare Disparities statistics & numerical data, Hypertension therapy, Primary Health Care
- Published
- 2012
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- View/download PDF
29. Impact of resident workload and handoff training on patient outcomes.
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Mueller SK, Call SA, McDonald FS, Halvorsen AJ, Schnipper JL, and Hicks LS
- Subjects
- Hospitals statistics & numerical data, Outcome Assessment, Health Care, Workload, Internship and Residency standards, Patient Care standards
- Published
- 2012
- Full Text
- View/download PDF
30. Electronic health records, clinical decision support, and blood pressure control.
- Author
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Samal L, Linder JA, Lipsitz SR, and Hicks LS
- Subjects
- Cross-Sectional Studies, Female, Health Care Surveys, Humans, Hypertension diagnosis, Male, Middle Aged, Physicians, Primary Care statistics & numerical data, Retrospective Studies, Statistics as Topic, United States, Blood Pressure, Decision Support Systems, Clinical instrumentation, Electronic Health Records, Hypertension prevention & control, Primary Health Care statistics & numerical data
- Abstract
Objectives: Adding clinical decision support (CDS) to electronic health records (EHRs) is required under meaningful use legislation, but there has been little national data on effectiveness in improving clinical outcomes. We sought to determine whether EHRs with CDS improved blood pressure control in US primary care visits., Study Design: We used a cross-sectional, nationally representative survey., Methods: We examined adult visits to primary care physicians using the 2007 and 2008 National Ambulatory Medical Care Survey (NAMCS)., Results: We found that patients had a mean age of 52 years, 34% were male, 15% had diabetes, and 70% were white. Rates of blood pressure control were significantly higher in visits where both an EHR and CDS (79%) were used, compared with visits where physicians used neither tool (74%; P = .004). Blood pressure control rates remained higher after adjusting for potential confounders. In unadjusted analyses, mean systolic blood pressure was 2 mm Hg lower in visits with the use of both an EHR and CDS, compared with visits where physicians used neither tool (P = .03), and this difference remained significant after adjustment., Conclusions: The NAMCS shows that physician use of an EHR with CDS is associated with improved blood pressure control. These findings are important because small improvements in blood pressure control are associated with reductions in cardiovascular morbidity and mortality.
- Published
- 2011
31. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey.
- Author
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Redmond N, Baer HJ, and Hicks LS
- Subjects
- Adult, Black or African American statistics & numerical data, Cross-Sectional Studies, Female, Health Surveys, Hispanic or Latino statistics & numerical data, Humans, Life Style, Male, Middle Aged, Odds Ratio, Risk Factors, Socioeconomic Factors, United States epidemiology, White People statistics & numerical data, Blood Pressure physiology, Health Behavior ethnology, Hypertension ethnology, Minority Health
- Abstract
Minorities have a higher prevalence of hypertension, a major risk factor for cardiovascular disease, which contributes to racial/ethnic disparities in morbidity and mortality in the United States. Many modifiable health behaviors have been associated with improved blood pressure control, but it is unclear how racial/ethnic differences in these behaviors are related to the observed disparities in blood pressure control. Cross-sectional analyses were conducted among 21 489 US adults aged >20 years participating in the National Health and Nutrition Examination Survey from 2001 to 2006. Secondary analyses were conducted among those with a self-reported diagnosis of hypertension. Blood pressure control was defined as systolic values <140 mm Hg and diastolic values <90 mm Hg (or <130 mm Hg and <80 mm Hg among diabetics, respectively). In primary analyses, non-Hispanic blacks had 90% higher odds of poorly controlled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). In secondary analyses among hypertensive subjects, non-Hispanic blacks and Mexican Americans had 40% higher odds of uncontrolled blood pressure compared with non-Hispanic whites after adjustment for sociodemographic and clinical characteristics (P<0.001). For both analyses, the racial/ethnic differences in blood pressure control persisted even after further adjustment for modifiable health behaviors, which included medication adherence in secondary analyses (P<0.001 for both analyses). Although population-level adoption of healthy behaviors may contribute to reduction of the societal burden of cardiovascular disease in general, these findings suggest that racial/ethnic differences in some health behaviors do not explain the disparities in hypertension prevalence and control.
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- 2011
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32. Publication of recruitment methods in focus group research of minority populations with chronic disease: a systematic review.
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Ndumele CD, Ableman G, Russell BE, Gurrola E, and Hicks LS
- Subjects
- Asthma ethnology, Cardiovascular Diseases ethnology, Chronic Disease, Humans, Hypertension ethnology, Mitochondrial Diseases, United States, Black or African American, Black People, Deafness ethnology, Diabetes Mellitus, Type 2 ethnology, Focus Groups, Hispanic or Latino, Minority Groups, Patient Selection
- Abstract
The relative effectiveness of strategies to recruit minority patients, populations traditionally difficult to engage in research, for focus groups is unclear. We conducted a systematic review of all peer-reviewed focus group studies targeting Black and/or Hispanic participants with diabetes, hypertension, asthma, and/or cardiovascular disease reported in Pubmed, MEDLINE, and CINAHL from January 1993 through August 2009. Reviewers extracted data on each study's characteristics, methods, and outcomes. Forty-five studies were eligible. While most described recruitment strategies, only 21 presented any metric of their success in recruiting participants. Among studies with high recruitment success rates, no discernable trends regarding effectiveness of recruitment strategies were found, largely due to variation in reporting of the use of incentives and follow-up mechanisms. Increased rigor is necessary for describing methodology of focus group research in the literature. It is incumbent upon researchers to ensure clear and detailed methodology in qualitative articles.
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- 2011
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33. Insurance status and hospital care for myocardial infarction, stroke, and pneumonia.
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Hasan O, Orav EJ, and Hicks LS
- Subjects
- Adolescent, Adult, Databases, Factual, Female, Health Care Costs, Healthcare Disparities, Hospital Mortality, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, United States, Young Adult, Hospitalization, Insurance Coverage statistics & numerical data, Insurance, Health statistics & numerical data, Myocardial Infarction economics, Pneumonia economics, Stroke economics
- Abstract
Background: Despite widely documented variations in health care outcomes by insurance status, few nationally representative studies have examined such disparities in the inpatient setting., Objective: To determine whether there are insurance-related differences in hospital care for 3 common medical conditions., Design and Subjects: Retrospective database analysis of 154,381 adult discharges (age 18-64 years) with a principal diagnosis of acute myocardial infarction (AMI), stroke, or pneumonia from the 2005 Nationwide Inpatient Sample (NIS)., Measurements: For each diagnosis, we compared in-hospital mortality, length of stay (LOS), and cost per hospitalization for Medicaid and uninsured patients with the privately insured., Results: Compared with the privately insured, in-hospital mortality among AMI and stroke patients was significantly higher for the uninsured (adjusted odds ratio [OR] 1.52, 95% confidence interval [CI] [1.24-1.85] for AMI and 1.49 [1.29-1.72] for stroke) and among pneumonia patients was significantly higher for Medicaid recipients (1.21 [1.01-1.45]). Excluding patients who died during hospitalization, LOS was consistently longer for Medicaid recipients for all 3 conditions (adjusted ratio 1.07, 95% CI [1.05-1.09] for AMI, 1.17 [1.14-1.20] for stroke, and 1.04 [1.03-1.06] for pneumonia), although costs were significantly higher for Medicaid recipients for only 2 of the 3 conditions (adjusted ratio 1.06, 95% CI [1.04-1.09] for stroke and 1.05 [1.04-1.07] for pneumonia)., Conclusions: In this nationally representative study of working-age Americans hospitalized for 3 common medical conditions, significantly lower in-hospital mortality was noted for privately insured patients compared with the uninsured or Medicaid recipients. Interventions to reduce insurance-related gaps in inpatient quality of care should be investigated.
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- 2010
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34. Perspectives of non-Hispanic Black and Latino patients in Boston's urban community health centers on their experiences with diabetes and hypertension.
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Russell BE, Gurrola E, Ndumele CD, Landon BE, O'Malley JA, Keegan T, Ayanian JZ, and Hicks LS
- Subjects
- Adult, Aged, Aged, 80 and over, Black People, Boston, Community Health Centers, Female, Focus Groups, Health Knowledge, Attitudes, Practice, Health Status Disparities, Hispanic or Latino, Humans, Male, Middle Aged, Needs Assessment, Urban Population, Black or African American, Attitude to Health, Diabetes Mellitus ethnology, Hypertension ethnology
- Abstract
Background: Racial/ethnic disparities exist in the prevalence and outcomes of diabetes and hypertension in the U.S. A better understanding of the health beliefs and experiences of non-Hispanic Blacks and Latinos with these diseases could help to improve their care outcomes., Methods: We conducted eight focus groups stratified by participants' race/ethnicity, with 34 non-Hispanic Blacks and Latinos receiving care for diabetes and/or hypertension in one of 7 community health centers in Boston. Focus groups were designed to determine participants' levels of understanding about their chronic illness, assess their barriers to the management of their illness, and inquire about interventions they considered may help achieve better health outcomes., Results: Among both groups of participants, nutrition (traditional diets), genetics and environmental stress (e.g. neighborhood crime and poor conditions) were described as primary contributors to diabetes and hypertension. Unhealthy diets were reported as being a major barrier to disease management. Participants also believed that they would benefit from attending groups on management and education for their conditions that include creative ways to adopt healthy foods that complement their ethnic diets, exercise opportunities, and advice on how to prevent disease manifestation among family members., Conclusions: Interactive discussion groups focused on lifestyle modification and disease management should be created for patients to learn more about their diseases. Future research evaluating the effectiveness of interactive diabetes and hypertension groups that apply patient racial/ethnic traditions should be considered.
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- 2010
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35. Sources of health information related to preventive health behaviors in a national study.
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Redmond N, Baer HJ, Clark CR, Lipsitz S, and Hicks LS
- Subjects
- Adolescent, Adult, Aged, Female, Health Care Surveys, Health Promotion methods, Humans, Logistic Models, Male, Mass Media, Middle Aged, Young Adult, Consumer Health Information methods, Health Behavior, Information Dissemination methods, Preventive Health Services methods
- Abstract
Background: Current literature suggests that certain sources of information are used in varying degrees among different socioeconomic and demographic groups; therefore, it is important to determine if specific classes of health information sources are more effective than others in promoting health behaviors., Purpose: This study aims to determine if interpersonal versus mass media sources of health information are associated with meeting recommendations for health behaviors (nonsmoking, fruit/vegetable intake, and exercise) and cancer screening., Methods: Multivariable logistic regression models were used to examine the relationship of health information sources (mass media sources including print, TV, Internet; and interpersonal sources including friends and family, community organizations, and healthcare providers) with meeting recommendations for healthy behaviors and cancer screening in the 2005 and 2007 Health Information National Trends Surveys (HINTS). Analyses were conducted in 2009., Results: In the 2005 HINTS, participants reporting use of print media and community organizations as sources of health information over the past year were mostly likely to meet recommendations for health behaviors. In the 2007 HINTS, utilization of healthcare providers for health information was associated with meeting recommendations for health behaviors, particularly cancer screening., Conclusions: Use of print media and interpersonal sources of health information are most consistently associated with self-reported health behaviors. Additional research should explore the relationship of health information sources to clinical outcomes. Social network interventions to promote adoption of health behaviors should be further developed., (2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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36. Impact of health disparities collaboratives on racial/ethnic and insurance disparities in US community health centers.
- Author
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Hicks LS, O'Malley AJ, Lieu TA, Keegan T, McNeil BJ, Guadagnoli E, and Landon BE
- Subjects
- Adult, Female, Humans, Male, Retrospective Studies, United States, Young Adult, Community Health Centers organization & administration, Ethnicity, Healthcare Disparities organization & administration, Insurance, Health organization & administration, Quality Assurance, Health Care
- Abstract
Background: The Health Resources and Services Administration Health Disparities Collaboratives (HDCs) were developed to improve care for chronic medical conditions in community health centers (CHCs)., Methods: We examined whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. We performed a controlled preintervention/postintervention study of 44 CHCs participating in HDCs for asthma, diabetes mellitus, or hypertension and 20 "external" control CHCs that had not participated. Each intervention center also served as an "internal" control for another condition. For each condition, we created an overall quality score, defined disparities in care as the differences in care between racial/ethnic groups and insurance groups, and examined changes in disparity through a series of hierarchical models using a 3-way interaction term among period, patient characteristics of interest, and treatment group., Results: Overall, HDCs had little effect on disparities in composite measures for asthma, diabetes, and hypertension. For asthma care, collaborative centers had a baseline Hispanic-white disparity of 6.5%, which changed to a higher quality of recommended care for Hispanic patients over white patients by 0.8%, resulting in a significantly reduced Hispanic-white disparity compared with the change in disparity seen in external controls (P = .04). There were no other improvements in racial/ethnic or insurance disparities for any other conditions., Conclusions: Although HDCs are known to improve quality of care in CHCs, they had minimal effect on racial/ethnic and insurance disparities. In addition to targeting improvement in overall quality, future initiatives should include activities aimed at disparity reduction as an outcome.
- Published
- 2010
- Full Text
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37. Disparities in adherence to hypertensive care in urban ambulatory settings.
- Author
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Ndumele CD, Shaykevich S, Williams D, and Hicks LS
- Subjects
- Black or African American statistics & numerical data, Aged, Ambulatory Care, Antihypertensive Agents administration & dosage, Diet, Sodium-Restricted, Female, Health Status Disparities, Health Surveys, Humans, Hypertension therapy, Male, Middle Aged, Patient Acceptance of Health Care statistics & numerical data, Patient Compliance statistics & numerical data, Socioeconomic Factors, United States, White People statistics & numerical data, Black or African American psychology, Hypertension ethnology, Patient Acceptance of Health Care ethnology, Patient Compliance ethnology, Urban Health Services statistics & numerical data, White People psychology
- Abstract
Nationally, a higher proportion of the medically underserved than of the general population suffer from hypertension. Poorer adherence to recommended therapies (including medication regimens, salt intake reduction, and regular visits with provider) has been linked to poorer blood pressure control. To identify whether differences in adherence are associated with racial/ethnic and socioeconomic characteristics, we administered a survey to 141 African American and non-Hispanic White hypertensive patients within two hospital-based clinics in an urban setting in the Northeast U.S. There were no differences in adherence to follow-up appointments or dietary recommendations between racial/ ethnic or income groups. However, there were differences between groups in adherence to medication regimens, with African Americans and lower-income groups significantly more likely to be non-adherent to medication regimens. When treating patients or implementing interventions aimed at improving adherence, special attention should be paid to African Americans and patients from low-income communities.
- Published
- 2010
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38. Strategies to improve chronic disease management in seven metro Boston community health centers.
- Author
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Ndumele CD, Russell BE, Ayanian JZ, Landon BE, Keegan T, O'Malley AJ, and Hicks LS
- Subjects
- Black or African American, Boston, Diabetes Mellitus prevention & control, Hispanic or Latino, Humans, Hypertension prevention & control, Medication Adherence, United States, Chronic Disease, Community Health Services organization & administration, Cooperative Behavior, Disease Management
- Published
- 2009
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- View/download PDF
39. Lifestyle modification counseling for hypertensive patients: results from the National Health and Nutrition Examination Survey 1999-2004.
- Author
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Lopez L, Cook EF, Horng MS, and Hicks LS
- Subjects
- Adult, Aged, Black People, Ethnicity, Female, Health Surveys, Hispanic or Latino, Humans, Hypercholesterolemia epidemiology, Hypertension epidemiology, Male, Middle Aged, Obesity epidemiology, Odds Ratio, Overweight epidemiology, Patient Compliance, Sex Factors, United States epidemiology, White People, Black or African American, Counseling statistics & numerical data, Hypertension therapy, Life Style
- Abstract
Background: Lifestyle modification is recommended for all patients with the diagnosis of hypertension., Methods: We examined 3,497 adult hypertensive participants (representing 42 million Americans), from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. We analyzed the rate, demographic, and clinical factors of participants who reported receiving lifestyle counseling and their adherence., Results: Of the 3,497 participants with hypertension, 84% reported receiving lifestyle modification counseling. After adjustment for demographic and clinical characteristics, non-Hispanic blacks were more likely to report receiving counseling (odds ratio (OR), 2.5; P < 0.001) when compared to whites. Men (OR, 1.5; P = 0.02) reported receiving counseling more often than women as well as those with Medicare insurance (OR, 1.5; P = 0.02) compared to the privately insured. Participants who were hypercholesterolemic (OR, 1.7; P < 0.001), diabetic (OR, 3.5; P < 0.001), overweight (OR, 1.5; P < 0.001), or obese (OR 3.0; P < 0.001) reported receiving lifestyle counseling more often than those without these conditions. Of those receiving counseling, 88% reported adhering to those recommendations. After adjustment for demographic and clinical characteristics, only non-Hispanic blacks (OR, 2.8; P < 0.001) and those aged >60 (OR, 1.9; P = 0.04) were more likely to report adhering when advised., Conclusions: High cardiovascular risk hypertensive patients had high rates of lifestyle counseling. However, gaps exist in lifestyle counseling for young and low cardiovascular risk hypertensive patients. In addition, differences in rates of adherence exist especially in those with high cardiovascular risk comorbid conditions. Future work is needed to increase adherence to lifestyle counseling for all hypertensive patients.
- Published
- 2009
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40. Experiences with hospital care: perspectives of black and Hispanic patients.
- Author
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Hicks LS, Tovar DA, Orav EJ, and Johnson PA
- Subjects
- Adult, Cardiovascular Diseases ethnology, Cardiovascular Diseases therapy, Female, Focus Groups, Humans, Male, Middle Aged, Pregnancy, Black People psychology, Hispanic or Latino psychology, Hospitalization, Patient Satisfaction ethnology
- Abstract
Background: Significant racial and ethnic differences along several dimensions of patients'experiences with hospital care have been previously documented. However, the relationship between these differences and possible differences in processes of care has not been well described., Methods: We conducted focus groups with 37 black and Hispanic men and women who had recently been discharged from either medical or obstetrical services at an urban academic medical center to assess which dimensions of these patients' experiences with care were most important in determining overall levels of satisfaction., Results: Differences were found between Hispanics and blacks in the factors that influence their overall positive and negative experiences. Participants identified two themes that influence experiences with hospital care that are not commonly examined in many patient satisfaction instruments: availability and quality of translators, and attitudes of social workers and nursing staff., Conclusions: Our findings suggest that hospitals should pursue hiring a culturally diverse work force and should collect racial and ethnically specific data about satisfaction with care including satisfaction with availability of social workers and interpreters.
- Published
- 2008
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41. Promoting access to renal transplantation: the role of social support networks in completing pre-transplant evaluations.
- Author
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Clark CR, Hicks LS, Keogh JH, Epstein AM, and Ayanian JZ
- Subjects
- Adolescent, Adult, Black or African American, Chi-Square Distribution, Delphi Technique, Demography, Female, Humans, Interviews as Topic, Kidney Failure, Chronic ethnology, Kidney Transplantation ethnology, Logistic Models, Male, Middle Aged, United States, White People, Health Services Accessibility, Kidney Failure, Chronic psychology, Kidney Failure, Chronic surgery, Kidney Transplantation psychology, Social Support
- Abstract
Background: Completing pre-transplant evaluations may be a greater barrier to renal transplantation for blacks with end-stage renal disease (ESRD) than for whites., Objective: To determine whether social support networks facilitate completing the pre-transplant evaluation and reduce racial disparities in this aspect of care., Design, Setting, and Participants: We surveyed 742 black and white ESRD patients in four regional networks 9 months after they initiated dialysis in 1996 and 1997. Patients reported instrumental support networks (number of friends or family to help with daily activities), emotional support networks (number of friends or family available for counsel on personal problems) and dialysis center support (support from dialysis center staff and patients). The completion of pre-transplant evaluations, including preoperative risk stratification and testing, was determined by medical record reviews., Outcome Measurement: Complete renal pre-transplant evaluations., Results: Compared to patients with low levels of instrumental support, those with high levels were more likely to have complete evaluations (25% versus 46%, respectively, p < .001). In adjusted analyses, high levels of instrumental support were associated with higher rates of complete evaluations among black women (p < .05), white women (p < .05), and white men (p < .05), but not black men. Among black men, but not other groups, private insurance was a significant predictor of complete evaluations., Conclusions: Instrumental support networks may facilitate completing renal pre-transplant evaluations. Clinical interventions that supplement instrumental support should be evaluated to improve access to renal transplantation. Access to supplemental insurance may also promote complete evaluations for black patients.
- Published
- 2008
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42. Impact of computerized decision support on blood pressure management and control: a randomized controlled trial.
- Author
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Hicks LS, Sequist TD, Ayanian JZ, Shaykevich S, Fairchild DG, Orav EJ, and Bates DW
- Subjects
- Academic Medical Centers, Black or African American, Aged, Antihypertensive Agents classification, Community Health Centers, Female, Hispanic or Latino, Hospitals, Group Practice, Humans, Hypertension ethnology, Male, Middle Aged, Primary Health Care, White People, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Decision Support Systems, Clinical, Healthcare Disparities, Hypertension drug therapy, Practice Patterns, Physicians' statistics & numerical data
- Abstract
Background: We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients., Methods: We randomized 2,027 adult patients receiving hypertension care in 14 primary care practices to either 18 months of their physicians receiving CDS for each hypertensive patient or to usual care without computerized support for the control group. We assessed prescribing of guideline-recommended drug therapy and levels of blood pressure control for patients in each group and examined if the effects of the intervention differed by patients' race/ethnicity using interaction terms., Measurements and Main Results: Rates of blood pressure control were 42% at baseline and 46% at the outcome visit with no significant differences between groups. After adjustment for patients' demographic and clinical characteristics, number of prior visits, and levels of baseline blood pressure control, there were no differences between intervention groups in the odds of outcome blood pressure control. The use of CDS to providers significantly improved Joint National Committee (JNC) guideline adherent medication prescribing compared to usual care (7% versus 5%, P < 0.001); the effects of the intervention remained after multivariable adjustment (odds ratio [OR] 1.39 [CI, 1.13-1.72]) and the effects of the intervention did not differ by patients' race and ethnicity., Conclusions: CDS improved appropriate medication prescribing with no improvement in disparities in care and overall blood pressure control. Future work focusing on improvement of these interventions and the study of other practical interventions to reduce disparities in hypertension-related outcomes is needed.
- Published
- 2008
- Full Text
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43. Access to specialty care and medical services in community health centers.
- Author
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Cook NL, Hicks LS, O'Malley AJ, Keegan T, Guadagnoli E, and Landon BE
- Subjects
- Adult, Community Health Centers statistics & numerical data, Economics, Medical, Health Services Accessibility economics, Humans, Insurance, Health statistics & numerical data, Male, Medicaid statistics & numerical data, Medically Underserved Area, Medicare statistics & numerical data, Middle Aged, Physician Executives, Primary Health Care economics, Primary Health Care organization & administration, Referral and Consultation economics, United States, Community Health Centers organization & administration, Health Care Surveys, Health Services Accessibility statistics & numerical data, Medically Uninsured statistics & numerical data, Medicine statistics & numerical data, Poverty, Referral and Consultation statistics & numerical data, Specialization
- Abstract
Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.
- Published
- 2007
- Full Text
- View/download PDF
44. Determinants of racial/ethnic differences in blood pressure management among hypertensive patients.
- Author
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Hicks LS, Shaykevich S, Bates DW, and Ayanian JZ
- Subjects
- Black or African American, Aged, Blood Pressure drug effects, Diabetes Mellitus epidemiology, Diabetes Mellitus ethnology, Female, Hispanic or Latino, Humans, Hypertension epidemiology, Hypertension ethnology, Male, Medical Records, Middle Aged, Office Visits, Prevalence, United States epidemiology, White People, Antihypertensive Agents therapeutic use, Hypertension drug therapy, Quality of Health Care trends
- Abstract
Background: Prior literature has shown that racial/ethnic minorities with hypertension may receive less aggressive treatment for their high blood pressure. However, to date there are few data available regarding the confounders of racial/ethnic disparities in the intensity of hypertension treatment., Methods: We reviewed the medical records of 1,205 patients who had a minimum of two hypertension-related outpatient visits to 12 general internal medicine clinics during 7/1/01-6/30/02. Using logistic regression, we determined the odds of having therapy intensified by patient race/ethnicity after adjustment for clinical characteristics., Results: Blacks (81.9%) and Whites (80.3%) were more likely than Latinos (71.5%) to have therapy intensified (P = 0.03). After adjustment for racial differences in the number of outpatient visits and presence of diabetes, there were no racial differences in rates of intensification., Conclusion: We found that racial/ethnic differences in therapy intensification were largely accounted for by differences in frequency of clinic visits and in the prevalence of diabetes. Given the higher rates of diabetes and hypertension related mortality among Hispanics in the U.S., future interventions to reduce disparities in cardiovascular outcomes should increase physician awareness of the need to intensify drug therapy more agressively in patients without waiting for multiple clinic visits, and should remind providers to treat hypertension more aggressively among diabetic patients.
- Published
- 2005
- Full Text
- View/download PDF
45. Control of hypertension in adults with chronic kidney disease in the United States.
- Author
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Peralta CA, Hicks LS, Chertow GM, Ayanian JZ, Vittinghoff E, Lin F, and Shlipak MG
- Subjects
- Female, Humans, Hypertension physiopathology, Male, Middle Aged, Prognosis, Systole, Treatment Outcome, United States, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension complications, Hypertension drug therapy, Kidney Failure, Chronic etiology
- Abstract
Although improved control of hypertension is known to attenuate progression of chronic kidney disease (CKD), little is known about the adequacy of hypertension treatment in adults with CKD in the United States. Using data from the Fourth National Health and Nutrition Survey, we assessed adherence to national hypertension guideline targets for patients with CKD (blood pressure <130/80 mm Hg), we assessed control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure, and we evaluated determinants of adequate blood pressure control. Presence of CKD was defined as glomerular filtration rate <60 mL/min per 1.73 m2 or presence of albuminuria (albumin:creatinine ratio >30 microg/mg). Multivariable logistic regression with appropriate weights was used to determine predictors of inadequate hypertension control and related outcomes. Among 3213 participants with CKD, 37% had blood pressure <130/80 mm Hg (95% confidence interval [CI], 34.5% to 41.8%). Of those with inadequate blood pressure control, 59% (95% CI, 54% to 64%) had systolic >130 mm Hg, with diastolic < or =80 mm Hg, whereas only 7% (95% CI, 3.9 to 9.8%) had a diastolic pressure >80 mm Hg, with systolic blood pressure < or =130 mm Hg. Non-Hispanic black race (odds ratio [OR], 2.4; 95% CI, 1.5 to 3.9), age >75 years (OR, 4.7; 95% CI, 2.7 to 8.2), and albuminuria (OR, 2.4; 95% CI, 1.4 to 4.1) were independently associated with inadequate blood pressure control. We conclude that control of hypertension is poor in participants with CKD and that lack of control is primarily attributable to systolic hypertension. Future guidelines and antihypertensive therapies for patients with CKD should target isolated systolic hypertension.
- Published
- 2005
- Full Text
- View/download PDF
46. Is hospital service associated with racial and ethnic disparities in experiences with hospital care?
- Author
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Hicks LS, Ayanian JZ, Orav EJ, Soukup J, McWilliams JM, Choi SS, and Johnson PA
- Subjects
- Adult, Black or African American psychology, Boston, Female, Health Care Surveys, Hispanic or Latino psychology, Hospital Departments standards, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Socioeconomic Factors, White People statistics & numerical data, Cultural Diversity, Hospital-Patient Relations, Hospitals, Teaching standards, Hospitals, Urban standards, Patient Satisfaction ethnology, Process Assessment, Health Care
- Abstract
Purpose: Little is known about the influence of processes of hospital care on racial and ethnic differences in experiences with hospital care., Subjects and Methods: To determine whether patient experiences differed by race and ethnicity and whether these differences were associated with hospital care characteristics, we analyzed survey and hospital administrative data from 2664 adult patients after hospitalization at an urban teaching hospital during 1998-1999. We assessed the association of patient race and ethnicity with reporting problems in multiple dimensions of patient experience, using logistic regression to adjust for sex, age, self-reported health status, insurance status, income, route of hospital admission, and hospital service. We then stratified adjusted analyses by hospital service., Results: After adjustment for demographic and hospital characteristics, black (odds ratio (OR): 1.8; 95% confidence interval [CI]: 1.3-2.6) and Latino (OR: 2.0; 95% CI: 1.3-3.0) patients reported more problems with respect for their preferences compared to whites. Blacks reported more problems with respect for their preferences (OR: 1.7; 95% CI: 1.0-3.0) among patients discharged from surgical services, and Latinos reported more problems with respect for their preferences (OR:3.6; CI: 1.6-8.2) among patients discharged from obstetrical services when compared to whites. Patient experiences did not significantly differ by race among patients discharged from medical services., Conclusions: We found significant racial and ethnic differences in patients' experiences with hospital care, particularly in respect for patient preferences. Our findings suggest physicians and hospital staff should strive to understand and address the expectations of black and Latino patients, particularly those who are hospitalized for surgical or obstetrical issues.
- Published
- 2005
- Full Text
- View/download PDF
47. Determinants of JNC VI guideline adherence, intensity of drug therapy, and blood pressure control by race and ethnicity.
- Author
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Hicks LS, Fairchild DG, Horng MS, Orav EJ, Bates DW, and Ayanian JZ
- Subjects
- Adult, Aged, Black People statistics & numerical data, Female, Hispanic or Latino statistics & numerical data, Humans, Logistic Models, Male, Middle Aged, United States epidemiology, White People statistics & numerical data, Black or African American, Antihypertensive Agents therapeutic use, Guideline Adherence statistics & numerical data, Hypertension ethnology, Hypertension prevention & control
- Abstract
The relationship between blood pressure control and racial differences in the processes of hypertension care have not been well examined. We reviewed medical records of 15 768 visits to 12 general internal medicine clinics during July 1, 2001 to June 30, 2002 to determine whether visits were adherent to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) by identifying medications selected for hypertension therapy. We compared JNC adherence, blood pressure control, and intensification of therapy by patient characteristics. Using repeated measures logistic regression, we determined the adjusted odds of obtaining blood pressure control when therapy was intensified the visit before, and tested the interaction of intensification of therapy and patient race/ethnicity in predicting blood pressure control. JNC adherence was more frequent among blacks (83.7%) and Hispanics (83%) than whites (78.4%) (P<0.001). Blood pressure was controlled most often among whites (38.7% versus 34.8% for blacks and 33.3% for Hispanics; P<0.001). Blacks (81.5%) and whites (80.9%) were more likely than Hispanics (70.8%) to have therapy intensified (P=0.02). After adjustment for baseline blood pressure, intensifying therapy was associated with higher odds of subsequent blood pressure control (odds ratio, 1.55; P<0.001). There were no significant interactions between race/ethnicity and intensification in predicting control. We found that therapy intensification is associated with subsequent blood pressure control in all racial/ethnic groups and that Hispanics were least likely to have their therapy intensified. Interventions to reduce disparities in cardiovascular outcomes should consider the need to intensify drug therapy more aggressively among all high-risk populations.
- Published
- 2004
- Full Text
- View/download PDF
48. Differences in health-related quality of life and treatment preferences among black and white patients with end-stage renal disease.
- Author
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Hicks LS, Cleary PD, Epstein AM, and Ayanian JZ
- Subjects
- Adolescent, Adult, Black or African American statistics & numerical data, Cross-Sectional Studies, Female, Humans, Kidney Failure, Chronic physiopathology, Kidney Failure, Chronic psychology, Kidney Transplantation, Male, Middle Aged, Regression Analysis, Renal Dialysis, Sickness Impact Profile, United States, White People statistics & numerical data, Black or African American psychology, Health Status, Kidney Failure, Chronic ethnology, Patient Satisfaction ethnology, Quality of Life, White People psychology
- Abstract
Background: Relatively little is known about racial differences in health-related quality of life (HRQL) among patients receiving dialysis for end-stage renal disease (ESRD) or how such differences may relate to preferences for renal transplantation., Methods: We surveyed 1392 patients, ages 18-54 approximately 10 months after they initiated dialysis in 4 regions of the United States. The HRQL measures analyzed were overall health, emotional health, physical activity, energy level, social activity, and effect of ESRD on daily life. We also examined whether the measures of HRQL were associated with patients' preferences for renal transplantation by race., Results: After adjustment for socioeconomic and clinical characteristics, Black women and men reported better overall health than White women and men, respectively. Black women reported higher energy levels than White women, and Black men reported less negative effects of ESRD on daily life compared to White men. Black men with high levels of physical activity were less likely to be certain about preferring a transplant than White men with similar levels of physical activity., Conclusions: Black patients receiving dialysis reported better HRQL than White patients, even after controlling for potential confounders. Racial differences in preferences for renal transplantation among men may be associated with their levels of physical activity.
- Published
- 2004
- Full Text
- View/download PDF
49. Association of region of residence and immigrant status with hypertension, renal failure, cardiovascular disease, and stroke, among African-American participants in the third National Health and Nutrition Examination Survey (NHANES III).
- Author
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Hicks LS, Fairchild DG, Cook EF, and Ayanian JZ
- Subjects
- Aged, Female, Geography, Humans, Male, Middle Aged, Nutrition Surveys, Prevalence, Risk Factors, United States epidemiology, Black or African American statistics & numerical data, Cardiovascular Diseases ethnology, Emigration and Immigration, Hypertension ethnology, Renal Insufficiency ethnology, Stroke ethnology
- Abstract
Objective: To determine whether current region of residence and immigrant status (born in the United States [US] vs abroad), are associated with the prevalence of hypertension (HTN), uncontrolled HTN, and HTN-related target-organ damage, among African Americans., Methods: We studied the survey and physical examination data from a nationally representative cohort of 3,369 self-designated Black participants, aged 30-79 years, in the third National Health and Nutrition Examination Survey (NHANES III), which took place during 1988-1994. We calculated the age-adjusted prevalence rates of HTN, uncontrolled HTN, and history of HTN-related target-organ damage in US-born northern African Americans, US-born southern African Americans, and foreign-born African Americans., Results: Hypertension (HTN) was more common among southern African-American men and women, compared to northern African-American men and women (42.2% vs 34.1%, P<.002 for men; 42.7% vs 37.2%, P=.02 for women). Uncontrolled HTN was also more common among hypertensive southern African-American women compared to hypertensive northern African-American women (79.8% vs 70.4%, P=.05). Among women, hypertensive Black immigrants had lower rates of HTN-related target-organ damage than either hypertensive US-born southern and northern African Americans (3.3% vs 16.3% and 15.8%, respectively, P=.05)., Conclusions: In this nationally representative cohort, immigrant status and geographic region of residence were associated with HTN prevalence, rates of blood pressure control, and HTN-related target-organ damage. Further examination of environmental exposures, cultural issues, and access to care, factors that can differ between groups, may yield important information about modifiable risk factors associated with HTN and target organ damage.
- Published
- 2003
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