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Minorities

Authors: Shone LP, Dick AW, Brach C, et al.
Date: 2003.
Title: The role of race and ethnicity in SCHIP in four states: are these baseline disparities, and what do they mean for SCHIP?
Publication: Pediatrics 112(6):521-32.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO16).

Authors: Brach C, Lewit EM, VanLandeghem K, et al.
Date: 2003
Title: Who's enrolled in SCHIP? Findings from the Child Health Insurance Research Initiative (CHIRI™).
Publication: Pediatrics 112(6):499-507.
Abstract: Available on PubMed®
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO15).

Authors: Elixhauser A, Weinick R, Betancourt J, et al.
Title: Differences in use of hospital procedures for Hispanics and non-Hispanic whites with cerebrovascular disease.
Publication: Ethn Dis 12(1):29-37.
Date: 2002
Abstract: Disparities in procedure use between racial/ethnic groups in the U.S. have been identified, yet differences between Hispanic and non-Hispanic white patients have been studies less frequently. The purpose of this study was to assess the in-hospital use of diagnostic and therapeutic procedures among Hispanics and non-Hispanic whites with transient cerebral ischemia or cerebrovascular disease. This study uses California and New York HCUP State Inpatient Databases for 1996. Hispanics had higher rates of non-invasive diagnostic testing (head CT scan, head and neck ultrasound, echocardiogram and head MRI). The odds of invasive diagnostic testing (cerebral arteriogram) and therapeutic procedures (carotid endarterectomy) were significantly lower for Hispanics. Most findings remained unchanged in logistic regression models with patient and hospital characteristics. Adding a measure of the concentration of Hispanic patients in the hospital eliminated differences or greatly reduced the level of disparity between Hispanics and non-Hispanic whites. Racial/ethnic differences in diagnostic procedure use may reflect poor communication and cultural/linguistic barriers between patients and providers, where diagnostic testing is used to compensate for an uninformative patient history.

Authors: Brach C, and Fraser I.
Title: Reducing Disparities through Cultural Competent Health Care: An Analysis of the Business Case.
Publication: Quality Management in Health Care 10(4):15-28.
Date: 2002
Abstract: The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. Health care organizations have financial incentives to become culturally competent, but limitations inherent in these incentives must be overcome if cultural competence is to become widespread.
Availability: AHRQ Publication No. 02-R081 is available from the AHRQ Publications Clearinghouse.

Authors: Andrews R, Elixhauser A.
Title: Access to major therapeutic procedures: Are Hispanics treated differently than non-Hispanic whites?
Publication: Ethn Dis 10(Autumn):59-69.
Date: 2000
Abstract: Available on PubMed®
Availability: AHRQ Publication No. 01-R016 is available from the AHRQ Publications Clearinghouse.

Authors: Brach C, Fraser I.
Title: Can cultural competency reduce ethnic and racial health disparities? A review and conceptual model.
Publication: Med Care Res Rev 57(Suppl 1):181-217.
Date: 2000
Abstract: This article investigates cultural competency's potential to reduce racial and ethnic health disparities through a review of both the cultural competency and disparities literatures and development of a conceptual model. It identifies nine major cultural competency techniques described in the literature (interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of indigenous community workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations). The authors model how cultural competency techniques could improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations that lead to good outcomes, thereby reducing disparities. The authors conclude that while there is substantial evidence to suggest that cultural competency should work, health systems have little evidence about which cultural competency techniques are in fact effective, and less evidence on when and how to implement them properly.
Availability: AHRQ Publication No. 01-R007 is available from the AHRQ Publications Clearinghouse. Copies of this journal supplement can be ordered from the Kaiser Family Foundation (1-800-656-4533, publication #3072).

Authors: Brach C, Scallet L.
Title: Managed care challenges for children and family services.
Publication: In Humane Managed Care?, edited by Schamess G, and Lightburn A. Washington (DC): National Association of Social Workers Press.
Date: 1998
Abstract: This chapter highlights five challenges facing those dedicated to the welfare of children and their families who also want to make the most of the opportunity managed care presents: (1) The speed with which managed care is moving through the various systems that serve children and families. (2) The emphasis that has been placed on outcomes. (3) The participation of clients in the design and implementation of managed care policies and programs and the importance of ensuring client protection. (4) The need for the development of culturally competent systems of care. (5) The potpourri of legal considerations that accompany managed care initiatives.

Authors: Harris D, Andrews R, Elixhauser A.
Title: Racial and gender differences in the use of procedures for black and white hospitalized adults.
Publication: Ethn Dis 7:91-105.
Date: 1997
Abstract: Available on PubMed®
Availability: AHCPR Publication No. 98-R018 is available from the AHRQ Publications Clearinghouse.

Author: Harris DR, Andrews R, Elixhauser A.
Title: Race/ethnicity and treatment of children and adolescents, by diagnosis.
Publication: Rockville (MD): AHCPR.
Date: 1996
Abstract: A number of recent studies have identified racial differences in treatment for selected diagnoses among adults. However, relatively few studies have examined treatment differences among children of different racial and ethnic groups. This Research Note examines treatment differences among children and adolescents by race/ethnicity across a comprehensive list of diagnoses in order to foster more research in this important area. Descriptive statistics are provided for 75 conditions treated on an inpatient basis; information is presented overall and separately by race/ethnicity (white, black, Hispanic, and other). This study used discharge abstract data on nearly 700,000 discharges of children and adolescents from the 1986 Hospital Cost and Utilization Project, a sample of about 10 percent of short-term, general, non-Federal hospitals in the United States. For each condition, statistics are provided on age, type of procedure, presence of complications, discharge status, disease stage, expected primary payer, length of stay and charges. Detailed tables allow comparison of racial/ethnic groups on all these variables. Otitis media is used as a case study to illustrate how these descriptive statistics can be used to design future research projects.
Availability: AHCPR Publication No. 96-0012 is available from the AHRQ Publications Clearinghouse.

Authors: Ball J, Elixhauser A.
Title: Treatment differences between black and white patients with colorectal cancer.
Publication: Med Care 1996:34(9):970-84.
Date: 1996
Abstract: The authors examine interracial variations in treatment for over 20,000 patients hospitalized with colorectal cancer in a national sample of hospitals. Blacks were more likely than whites to be hospitalized with oncologic sequelae, diagnoses indicating advanced disease, which may capture the effects of unmanaged or poorly managed cancer. Inpatient mortality was equivalent only for the most severely ill. Otherwise, the odds of inpatient mortality were 59 percent to 98 percent higher for blacks than whites. Treatment, in terms of procedure type, was equivalent only for the sickest patients. Among the less severely ill, blacks were less likely than whites to receive major therapeutic procedures. Multiple findings suggest that blacks with colorectal cancer were hospitalized with more severe conditions and treated less aggressively than whites. In an era of health care reform, such differences, which are net of insurance effects, may require more than universal insurance coverage to be overcome.
Availability: AHCPR Publication No. 96-R131 is available from the AHRQ Publications Clearinghouse.

Author: Brach C.
Title: Cultural competency and managed care.
Publication: Washington (DC): Mental Health Policy Resource Center.
Date: 1996
Abstract: This brief publication discusses why and how managed care organizations are likely to become culturally competent, identifies the five components of culturally competent care, and lists selected resources.

Author: Harris DR, Andrews R, Elixhauser A.
Title: Race/Ethnicity and Treatment of Children and Adolescents, by Diagnosis.
Publication: Rockville (MD): AHCPR.
Date: 1996
Abstract: A number of recent studies have identified racial differences in treatment for selected diagnoses among adults. However, relatively few studies have examined treatment differences among children of different racial and ethnic groups. This Research Note examines treatment differences among children and adolescents by race/ethnicity across a comprehensive list of diagnoses in order to foster more research in this important area. Descriptive statistics are provided for 75 conditions treated on an inpatient basis; information is presented overall and separately by race/ethnicity (white, black, Hispanic, and other). This study used discharge abstract data on nearly 700,000 discharges of children and adolescents from the 1986 Hospital Cost and Utilization Project, a sample of about 10 percent of short-term, general, non-Federal hospitals in the United States. For each condition, statistics are provided on age, type of procedure, presence of complications, discharge status, disease stage, expected primary payer, length of stay and charges. Detailed tables allow comparison of racial/ethnic groups on all these variables. Otitis media is used as a case study to illustrate how these descriptive statistics can be used to design future research projects.
Availability: AHCPR Publication No. 96-0012 is available from the AHRQ Publications Clearinghouse.

Author: Andrews R, Harris DR, Elixhauser A.
Title: Gender, race/ethnicity, and treatment of adults in hospital diagnosis
Publication: Rockville (MD): AHCPR.
Date: 1995
Abstract: Recent studies have identified differences in treatment for a few selected diagnoses based on race and gender. The extent to which such differences exist for all diagnoses and treatments is unknown. In addition, there has been almost no research on ethnic (Hispanic/non-Hispanic) differences in treatment. This Research Note examines treatment differences by gender and race/ethnicity across a comprehensive list of diagnoses in order to foster more research in this important area. This Research Note provides information on 100 conditions treated on an inpatient basis; descriptive statistics are presented overall and separately by gender and race/ethnicity (white, black, Hispanic, and other). This study used discharge abstract data on more than 3 million discharges from the 1986 Hospital Cost and Utilization Project, a sample of about 500 short-term, general, non-Federal hospitals in the United States. For each condition, statistics are provided on age, type of procedure, presence of complications, discharge status, disease stage, expected primary payer, length of stay, and charges. Detailed tables allow comparison of racial/ethnic groups overall and by gender on all these variables. Alcohol, drug abuse, and mental health diagnoses are used as a case study to provide an example of how these descriptive statistics can be used to design future research projects.
Availability: AHCPR Publication No. 96-0011 is available from the AHRQ Publications Clearinghouse.

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