Richard Conviser

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Richard Conviser Moses Pounds, Co-Project
OfficersUS Department of Health and Human
ServicesHealth Resources and Services
Administration HIV/ AIDS Bureau Division of
Science and Policy August, 2006
Addressing Disparities in Minority Care Access
and Outcomes
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Project Goals

• Document racial/ethnic disparities in access to
  and utilization of care
• Use techniques for assessing provider-patient
  interactions to determine their degree of
  cultural competency and patient-centeredness.
• Describe implement potential interventions to
  reduce disparities in care

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Provider-Patient Communication Background

• Project is jointly funded by the Minority AIDS
  Initiative (MAI) and the CARE Acts Special
  Projects of National Significance (SPNS)
• Project is taking place at four CARE Act-funded
  primary care sites that are members of the HIV
  Research Network

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HIV Research Network

• The Network and its Data Collection Center (DCC)
  at Johns Hopkins Medical Center has been
  receiving partial support from HRSA through the
  IAA with AHRQ.

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HIV Research Network (contd)

• The DCC, as the focus of the Network, receives,
  analyzes, and disseminates information about
  changing patterns and costs of HIV resource use
  on the basis of data submitted by 17 HIV provider
  organizations around the nation, caring for on
  the order of 15,000 patients annually.

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HIV Research Network (contd)

• Data published by the Network has shown that
  there are persistent racial/ethnic and gender
  disparities in access to state-of-the-art
  antiretroviral treatment.

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Evaluation Design

• This is a 3-year evaluation study conducted
  through a limited competition among eligible HIV
  Research Network members
• Focuses on ways to reduce disparities in care
  access and quality experienced by minority
  populations (primarily African Americans and
  Hispanics) and women. 

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Evaluation Design (contd)

• To be considered for participation, applicants
  (Network sites that are CARE Act providers,
  including both Title III and IV grantees and
  sub-contractors to Title I and II grantees) had
  to provide preliminary documentation of the
  existence of disparities in access to care among
  clients whom they are treating from these
  populations. 

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Evaluation Design (contd)

• Each site will collect data from both providers
  and clients
• Surveys filled out by each
• With appropriate permissions
• Interactions will be audio-recorded
• The audio recordings will be analyzed according
  to an already developed scheme
• Goal to discover factors that may be related to
  disparities in care access and outcomes
• This information will influence the development
  of interventions

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Evaluation Design (contd)

• The providers will implement interventions
  intended to enhance their ability to better serve
  these populations. 
• The interventions will focus on
• client empowerment
• provider cultural competency
• client health literacy and/or
• enhancing the availability of services tailored
  to the needs of racial/ethnic minority and/or
  immigrant populations (e.g., translation
  services) and the needs of women.

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Four CARE Act Provider Sites Data Coordinating
Center

• St. Lukes-Roosevelt Hospital, NY
• Wayne State University, Detroit
• Oregon Health and Science University, Portland
  (OR)
• Johns Hopkins University, Baltimore
• Johns Hopkins Medical Center is also the Data
  Coordinating Center for all sites

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Characteristics of the Sites and Replicability

• Network members all have experience in providing
  HIV care to minority populations and have data on
  the services provided.
• To the extent possible, interventions at the four
  study sites will be similar, and similar data
  will be collected

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Dissemination and Replicability

• Sites are CARE Act providers (Title III or IV
  grantees or sub-contractors to Title I or II
  grantees)
• The proposed study is immediately applicable to
  CARE Act providers and the populations they serve
• Goal to develop their capacity to expand
  participation in HIV care and treatment by women
  and minority populations.

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Dissemination and Replicability (contd)

• Through presentations to HAB staff, CARE Act
  grantees, and professional organizations.
• Practical publications for clinicians, provider
  agencies and policy makers.
• Technical assistance modules and activities.

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Contact Information

• Moses B. Pounds
• HRSA/HAB/DSP
• 5600 Fishers Lane, Rm 7C07
• Rockville, MD 20857
• Telephone [phone]
• E-mail mpounds_at_hrsa.gov