Is “Asian” a Meaningful Category for Studying and Reporting Health and Health Care Disparities? A Comparison of Filipino and Chinese Kaiser Permanente Northern California Members Aged 25–79 on Health Status, Selected Health Behaviors, and Use of the Patient Portal

256 Background: Chemotherapy regimens for early-stage breast cancer have been extensively tested by randomized clinical trials, and specified by evidence based-practice guidelines. However, little is known about the translation of trial results and guidelines to oncology practice. Methods: We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated health-care delivery system serving 29% of the local population. We linked data to the California Cancer Registry, incorporating demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. Results: We identified 6,178 women diagnosed with stage I to III breast cancer at KPNC during 2004 to 2007; 2,735 (44.3%) received at least one chemotherapy infusion at KPNC within 18 months of diagnosis. Factors associated with receiving chemotherapy, and specifically receiving anthracyclines, taxanes, and/or trastuzumab, included young age, large tumor size, involved lymph nodes, hormone receptor-negative or HER2/neu-positive tumors, and high tumor grade; comorbid conditions were inversely associated with chemotherapy use (heart disease for anthracyclines, neuropathy for taxanes). We observed less chemotherapy use by unmarried women, less anthracycline and taxane use by low-socioeconomic status (SES) non-Hispanic whites, and more anthracycline use by high-SES Asian/Pacific Islanders (versus high-SES non-Hispanic whites). Concordance with relevant measures of the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) was highest among younger women with larger, higher grade tumors. Conclusions: In this health care organization with essentially equal access, we discovered that chemotherapy use was concordant with practice guidelines, yet may vary according to socio-demographic factors. These findings may inform efforts to optimize treatment, and guide studies of quality in breast cancer care.

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Adjusting for health status in non-linear models of health care disparities

Health Services and Outcomes Research Methodology ◽

10.1007/s10742-008-0039-6 ◽

2008 ◽

Vol 9 (1) ◽

pp. 1-21 ◽

Cited By ~ 29

Author(s):

Benjamin L. Cook ◽

Thomas G. McGuire ◽

Ellen Meara ◽

Alan M. Zaslavsky

Keyword(s):

Health Care ◽

Health Status ◽

Health Care Disparities ◽

Linear Models ◽

Non Linear

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Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers are Measured Matters

Public Health Reports ◽

10.1177/003335490512000409 ◽

2005 ◽

Vol 120 (4) ◽

pp. 418-430 ◽

Cited By ~ 105

Author(s):

Glenn Flores ◽

Milagros Abreu ◽

Sandra C. Tomany-Korman

Keyword(s):

Health Care ◽

Health Status ◽

Health Care Disparities ◽

English Proficiency ◽

Language Barriers ◽

Children's Health ◽

Children’S Health ◽

Primary Language ◽

Language Spoken At Home ◽

At Home

Background. Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

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Factors Affecting Portal Usage Among Chronically Ill Patients During the COVID-19 Pandemic in the Netherlands: Cross-sectional Study (Preprint)

10.2196/preprints.26003 ◽

2020 ◽

Author(s):

Qingxia Kong ◽

Danique Riedewald ◽

Marjan Askari

Keyword(s):

Health Care ◽

Life Satisfaction ◽

Health Status ◽

Health Care Providers ◽

Waiting Time ◽

Chronically Ill ◽

Patient Portal ◽

Care Providers ◽

Patient Portals ◽

Willingness To Recommend

BACKGROUND The COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users’ satisfaction among patients who are chronically ill during the COVID-19 pandemic. OBJECTIVE This study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers. METHODS An online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of four parts: (1) demographics including age and hours of daily internet use; (2) physical health status including COVID-19 infection, perceived level of control, and hospital visits; (3) mental health status including depression and life satisfaction; and (4) portal use including response waiting time and awareness. Descriptive, correlation, univariate, and multivariate analyses were conducted to identify factors that affect portal use, users’ willingness to recommend, and nonusers’ likelihood of future portal use. RESULTS A total of 652 patients responded, and 461 valid questionnaires were included. Among the 461 patients, 67% (n=307) were identified as patient portal users. Of the nonusers, 55% (85/154) reported not being aware of the existence of a patient portal at their hospital. Significant predictors of portal use include level of control (P=.04), hospital visit time (P=.03), depression scale (P=.03), and status of life satisfaction (P=.02). Among portal users, waiting time to get a response via the portal (P<.001) and maximum acceptable waiting time (P<.001) were the strongest predictors for willingness to recommend the portal; among nonusers, the model predicted that those who were not aware of patient portals (P<.001) and were willing to wait moderately long (P<.001) were most likely to use the portal in the future. CONCLUSIONS This study provides insights into factors that influence portal use and willingness to recommend, based on which health care providers can improve the adoption of patient portals and their services. It suggests that health care providers should leverage efficient operations management to improve responsiveness and reduce waiting time to enhance user satisfaction and willingness to recommend use. Health care organizations need to increase portal awareness among nonusers and train their patients to increase both use and longer adoption of patient portals. Factors including depression and life satisfaction can influence portal use; therefore, future studies on determinants of portal use and nonuse in this specific population are needed.

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LGBT health-care disparities in Multiple Sclerosis: a cross-sectional web-based study in Italy (Preprint)

10.2196/preprints.6266 ◽

2016 ◽

Author(s):

Luigi Lavorgna ◽

Marcello Moccia ◽

Antonio Russo ◽

Raffaele Palladino ◽

Lucia Riccio ◽

...

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Sexual Orientation ◽

Health Status ◽

Health Care Disparities ◽

Psychological Services ◽

Multiple Choice Questions ◽

Cross Sectional ◽

Bisexual And Transgender ◽

Socio Demographic Factors

BACKGROUND Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. OBJECTIVE To investigate health-care disparities experienced by LGBT patients with multiple sclerosis (MS). METHODS We conducted a survey on an Italian social-network (www.smsocialnetwork.com) for MS patients, by using standardized multiple-choice questions. The survey investigated: socio-demographic factors, lifestyle habits, MS-related health status and LGBT specific issues (e.g. friendliness to their sexual orientation or homophobic behaviors from the staff of their MS Center). RESULTS LGBT patients were associated with a smaller number of psychological consultations, compared to heterosexuals (Coeff.=-0.449; p<0.001; 95%CI=-0.682--0.217). LGBT patients were more likely to change MS Center, compared to heterosexuals (OR=2.064; p=0.046; 95%CI=1.011-4.212). The number of MS Center changes was associated with MS Center friendliness (p=0.037; rho=-0.229) and with the occurrence of homophobic behaviors (p=0.036; rho=0.234). CONCLUSIONS LGBT MS patients more frequently changed MS Center and had a reduced use of psychological services, compared to heterosexuals. The attitude towards LGBT MS patients might affect resource utilizations and, possibly, LGBTs’ health status.

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The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review

Journal of Medical Internet Research ◽

10.2196/26189 ◽

2021 ◽

Vol 23 (9) ◽

pp. e26189

Author(s):

Elettra Carini ◽

Leonardo Villani ◽

Angelo Maria Pezzullo ◽

Andrea Gentili ◽

Andrea Barbara ◽

...

Keyword(s):

Health Care ◽

Health Status ◽

Health Outcomes ◽

Utilization Rate ◽

Patient Portal ◽

System Efficiency ◽

Patient Attitudes ◽

Patient Portals ◽

The Impact ◽

Health Care Efficiency

Background Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency.

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The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review (Preprint)

10.2196/preprints.26189 ◽

2020 ◽

Author(s):

Elettra Carini ◽

Leonardo Villani ◽

Angelo Maria Pezzullo ◽

Andrea Gentili ◽

Andrea Barbara ◽

...

Keyword(s):

Health Care ◽

Health Status ◽

Health Outcomes ◽

Utilization Rate ◽

Patient Portal ◽

System Efficiency ◽

Patient Attitudes ◽

Patient Portals ◽

The Impact ◽

Health Care Efficiency

BACKGROUND Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. OBJECTIVE The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. METHODS We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. RESULTS Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. CONCLUSIONS Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency.

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The South Australia Health Chronic Disease Self-Management Internet Trial

Health Education & Behavior ◽

10.1177/1090198112436969 ◽

2012 ◽

Vol 40 (1) ◽

pp. 67-77 ◽

Cited By ~ 46

Author(s):

Kate Lorig ◽

Philip L. Ritter ◽

Kathryn Plant ◽

Diana D. Laurent ◽

Pauline Kelly ◽

...

Keyword(s):

Health Care ◽

Chronic Disease ◽

Health Status ◽

Health Behaviors ◽

Self Efficacy ◽

South Australia ◽

Management Program ◽

Self Management ◽

Large Numbers ◽

Health Status Measures

Objectives. To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method. Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures, seven behaviors, and four utilization measures; self-efficacy; and health care satisfaction. Results. Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data. One hundred forty-four completed 6 months and 194 completed 1 year. Significant improvements ( p < .05) were found at 6 months for four health status measures, six health behaviors, self-efficacy, and visits to emergency departments. At 12 months, five health status indicators, six health behaviors, self-efficacy, and visits to emergency departments remained significant. Satisfaction with health care trended toward significance. Discussion. The peer-led online program was both acceptable and useful for this population. It appeared to decrease symptoms, improve health behaviors, self-efficacy, and reduce health care utilization up to 1 year. This intervention also has large potential implications for the use of a public health education model for reaching large numbers of people. It demonstrates that an Internet self-management program, which includes social media, can reach rural and underserved people as well as be effective and reduce health care costs. If this intervention can be brought to scale, it has the potential for improving the lives of large numbers of people with chronic illness. It represents a way the medical care and public health sectors can interact.

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