The Agency for Healthcare Research and Quality (AHRQ) has funded the "Center of Excellence on Overcoming Racial Health Disparities," a five year program project grant based at the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill. The Glaxo Wellcome Foundation-funded UNC Program on Health Outcomes provides additional funding for the program center. This is a multi-disciplinary, multi-university program project grant. UNC-CH is partnered with North Carolina Central University and Shaw University.
There are three funded projects within the Center of Excellence on Overcoming Racial Health Disparities:
Racial Differences in Prostate Cancer Outcomes:
Dr. Paul Godley is the Principal Investigator for this four-year project that will examine racial differences and prostate cancer outcomes. Prostate cancer poses significant burdens of mortality and morbidity on black men, greater than white men, especially in the southeastern US. We propose to examine the disparities and the reasons for them. Prostate cancer in black men is diagnosed at a later stage with a worse prognosis.
Research questions for this specific project are: (1) Do black men receive less aggressive treatment for localized prostate cancer than white men? (2) Do black men with prostate cancer have a history of less frequent screening with prostate specific antigen (PSA) than white men with cancer? (3) Are knowledge, attitudes and beliefs regarding prostate cancer screening and treatment different between black and white men who have prostate cancer?
This will be a case-case study of 300 incident cases of prostate cancer among black men and 300 incident cases of prostate cancer among white men age 65 and older in a 33 county area of North Carolina. The cases will be identified from the North Carolina Central Cancer Registry. After obtaining permission from the patient physician, we propose to obtain medical records and to conduct a detailed telephone interview to assess multiple factors including demographics, income and poverty levels, education, social support, attitudes toward screening tests with use of PSA, stage of cancer, and types of treatments used.
This study will determine whether initial treatments could account for racial disparities and treatment outcomes and also whether attitudes toward screening in general, and prostate cancer in particular, or other factors appear to explain these differences. The examination of multiple possible factors for which race may serve as an indicator will substantially improve our understanding of the underlying factors within racial disparities and prostate cancer. We hope that the results of this study can directly lead to targeted interventions in this area.
Service Coordination for Patients with HIV and STD Infection:
Dr. James Thomas is the Principal Investigator for "Service Coordination with Patients with HIV and STD Infection." Rates of infection with HIV and other sexually transmitted diseases are orders of magnitude greater among blacks than among whites. Prevention of HIV is complex, requiring the cooperation and coordination of service providers and networks of care. The characteristics of individual institutions and institutional networks can differentially affect black and white care seeking and service provision. We will conduct the first quantitative study of these characteristics as they relate to HIV and other STDs.
We will adapt instruments used in the field of mental health services research to quantitatively characterize systems of care. The instruments will be adapted to identify racially based disparities present in individual care providers and local networks of service provision in 12 North Carolina counties. One set of data will be collected from 15 to 20 service providers in each of 12 North Carolina counties. We anticipate the service relationships will differ from urban and rural counties according to the distributions of income by race in that county. Half of the counties selected will be rural and half urban, to facilitate comparisons on an urban-rural basis. We will also measure perceived system-level performance characteristics captured from key informants. The selections of the respondents and organizations to be interviewed will be stratified by race in order to insure a comprehensive view of any race-based differences in perceived or actual barriers to HIV/STD prevention services. We anticipate that the study will identify (1) service characteristics of institutions and institutional care networks that suggest racially based barriers to HIV/STD prevention services, and (2) a survey instrument that can be used in other communities to systematically identify inadequacy in the coordination of HIV/STD prevention services.
Racial Concordance and Outcomes of Care for Black Patients with High Blood Pressure:
The third study, led by Dr. Thomas Konrad, is "Racial Concordance and Outcomes of Care for Black Patients with High Blood Pressure." One proposed approach to addressing racial disparities and health outcomes examines the racial composition of providers of health care, to determine whether patient’s satisfaction and health outcomes are influenced when the patient and the physician are of the same or different race. We will measure the extent of racial concordance between patients and physicians and examine whether racial concordance is related to several medical care processes. For a subset of hypertensive patients we will document patterns of care for the four possible physician/patient racial groups. We will also determine the impact of racial concordance on rates of undetected hypertension, compliance to recommended therapy, and control of hypertension.
We will use existing data from the Piedmont Health Survey of the Elderly (PHSE), a population-based sample of 1,600 community-based elders. In this survey, blacks were over-sampled (50% of the sample with 318 patients reporting a black physician as a usual source of care). Sample weights will allow us to adjust for the over-sampling of black subjects, permitting generalization to the population as a whole. We will merge this data set with physician information from the North Carolina medical licensure files so that we will have information on both patient and their usual source of medical care.
We will analyze the relationship between the social and clinical profiles of the respondents, the characteristics of their primary care physician, and several patient care measures including patterns of preventive care services, use of service and satisfaction with care. We will use multi-level multi-variate analyses to predict outcomes based on physician-patient racial concordance, length of the physician-patient relationship, and health care needs. Specific dependent variables will include: receipt of preventive care associated with hypertension, level of hypertension control, satisfaction with care, and use of emergency room care. These analyses will provide insights into the roles of physician and patient race and the processes of medical care.
Seminar Series on Methods in Health Disparities Research: