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RCD 06-287 – HSR&D Study

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RCD 06-287
Identifying Mechanisms Linking Perceived Discrimination & Health
Leslie R. M. Hausmann PhD MS
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, PA
Funding Period: April 2007 - March 2014

BACKGROUND/RATIONALE:
Perceived discrimination is associated with many negative health outcomes and behaviors. However, the mechanisms underlying these relationships remain unknown and few interventions to reduce the impact of discrimination on health exist.

OBJECTIVE(S):
The objectives of this Career Development Award (CDA) were to (1) conduct research to identify mechanisms by which patient perceptions of discrimination impact health behaviors and outcomes, and (2) inform the development of patient-level and provider-level interventions to reduce the impact of discrimination on health behaviors and outcomes.

METHODS:
A variety of research methods were used to examine the impact of perceived discrimination on patient health behaviors and outcomes. Secondary database analyses were used to identify the association of perceived discrimination with health-related outcomes in the general population, in Veterans, and in patients with specific clinical conditions (e.g., hypertension), and to illuminate variables that mediate the association of discrimination with outcomes. Primary data collection was used to provide additional information about the presence and impact of perceived discrimination among Veterans, and to identify possible mediating variables to guide the development of patient- and provider-focused interventions to reduce the impact of discrimination on health-related outcomes among Veterans.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Many VHA patients belong to racial and socioeconomic groups that are at increased risk of experiencing or perceiving acts of discrimination, which is a risk factor for poor health behaviors and outcomes. The work supported by this CDA represents an important step towards mitigating the impact of discrimination on health and alleviating health disparities among Veterans that may be due, in part, to discrimination..

PUBLICATIONS:

Journal Articles

  1. Jones AL, Hanusa BH, Appelt CJ, Haas GL, Gordon AJ, Hausmann LR. Racial Differences in Veterans' Satisfaction With Addiction Treatment Services. Journal of addiction medicine. 2015 Sep 1; 9(5):383-90.
  2. Vina ER, Hausmann LR, Utset TO, Masi CM, Liang KP, Kwoh CK. Perceptions of racism in healthcare among patients with systemic lupus erythematosus: a cross-sectional study. Lupus science & medicine. 2015 Aug 20; 2(1):e000110.
  3. Trivedi AN, Nsa W, Hausmann LR, Lee JS, Ma A, Bratzler DW, Mor MK, Baus K, Larbi F, Fine MJ. Quality and equity of care in U.S. hospitals. The New England journal of medicine. 2014 Dec 11; 371(24):2298-308.
  4. Lee JS, Nsa W, Hausmann LR, Trivedi AN, Bratzler DW, Auden D, Mor MK, Baus K, Larbi FM, Fine MJ. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010. JAMA internal medicine. 2014 Nov 1; 174(11):1806-14.
  5. Burgess DJ, Taylor BC, Phelan S, Spoont M, van Ryn M, Hausmann LR, Do T, Gordon HS. A brief self-affirmation study to improve the experience of minority patients. Applied psychology. Health and well-being. 2014 Jul 1; 6(2):135-50.
  6. Hausmann LR, Parks A, Youk AO, Kwoh CK. Reduction of bodily pain in response to an online positive activities intervention. The journal of pain : official journal of the American Pain Society. 2014 May 1; 15(5):560-7.
  7. Hausmann LR, Gao S, Mor MK, Schaefer JH, Fine MJ. Patterns of sex and racial/ethnic differences in patient health care experiences in US Veterans Affairs hospitals. Medical care. 2014 Apr 1; 52(4):328-35.
  8. Hausmann LR, Gao S, Mor MK, Schaefer JH, Fine MJ. Understanding racial and ethnic differences in patient experiences with outpatient health care in Veterans Affairs Medical Centers. Medical care. 2013 Jun 1; 51(6):532-9.
  9. Hausmann LR, Kwoh CK, Hannon MJ, Ibrahim SA. Perceived racial discrimination in health care and race differences in physician trust. Race and social problems. 2013 Jun 1; 5(2):113-120.
  10. Hausmann LR, Gao S, Lee ES, Kwoh CK. Racial disparities in the monitoring of patients on chronic opioid therapy. Pain. 2013 Jan 1; 154(1):46-52.
  11. Ayotte BJ, Hausmann LR, Whittle J, Kressin NR. The relationship between perceived discrimination and coronary artery obstruction. American heart journal. 2012 Apr 1; 163(4):677-83.
  12. Brondolo E, Hausmann LR, Jhalani J, Pencille M, Atencio-Bacayon J, Kumar A, Kwok J, Ullah J, Roth A, Chen D, Crupi R, Schwartz J. Dimensions of perceived racism and self-reported health: examination of racial/ethnic differences and potential mediators. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2011 Aug 1; 42(1):14-28.
  13. Hausmann LR, Hannon MJ, Kresevic DM, Hanusa BH, Kwoh CK, Ibrahim SA. Impact of perceived discrimination in healthcare on patient-provider communication. Medical care. 2011 Jul 1; 49(7):626-33.
  14. Hausmann LR, Hanusa BH, Kresevic DM, Zickmund S, Ling BS, Gordon HS, Kwoh CK, Mor MK, Hannon MJ, Cohen PZ, Grant R, Ibrahim SA. Orthopedic communication about osteoarthritis treatment: Does patient race matter? Arthritis care & research. 2011 May 1; 63(5):635-42.
  15. Hausmann LR, Ren D, Sevick MA. Racial differences in diabetes-related psychosocial factors and glycemic control in patients with type 2 diabetes. Patient preference and adherence. 2010 Sep 7; 4:291-9.
  16. Hausmann LR, Mor M, Hanusa BH, Zickmund S, Cohen PZ, Grant R, Kresevic DM, Gordon HS, Ling BS, Kwoh CK, Ibrahim SA. The effect of patient race on total joint replacement recommendations and utilization in the orthopedic setting. Journal of general internal medicine. 2010 Sep 1; 25(9):982-8.
  17. Hausmann LR, Kressin NR, Hanusa BH, Ibrahim SA. Perceived racial discrimination in health care and its association with patients' healthcare experiences: does the measure matter? Ethnicity & disease. 2010 Jan 1; 20(1):40-7.
  18. Hausmann LR, Jeong K, Bost JE, Kressin NR, Ibrahim SA. Perceived racial discrimination in health care: a comparison of Veterans Affairs and other patients. American journal of public health. 2009 Nov 1; 99 Suppl 3:S718-24.
  19. Hausmann LR, Ibrahim SA, Mehrotra A, Nsa W, Bratzler DW, Mor MK, Fine MJ. Racial and ethnic disparities in pneumonia treatment and mortality. Medical care. 2009 Sep 1; 47(9):1009-17.
  20. Hausmann LR, Ye F, Schofield JW, Woods RL. Sense of belonging and persistence in white and African American first-year students. Research in Higher Education. 2009 Aug 1; 50(7):649-669.
  21. Siminoff LA, Hausmann LR, Ibrahim S. Barriers to obtaining diagnostic testing for coronary artery disease among veterans. American journal of public health. 2008 Dec 1; 98(12):2207-13.
  22. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and use of preventive health services. Journal of general internal medicine. 2008 Oct 1; 23(10):1679-84.
  23. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Medical care. 2008 Sep 1; 46(9):905-14.
  24. Sevick MA, Zickmund S, Korytkowski M, Piraino B, Sereika S, Mihalko S, Snetselaar L, Stumbo P, Hausmann L, Ren D, Marsh R, Sakraida T, Gibson J, Safaien M, Starrett TJ, Burke LE. Design, feasibility, and acceptability of an intervention using personal digital assistant-based self-monitoring in managing type 2 diabetes. Contemporary clinical trials. 2008 May 1; 29(3):396-409.
  25. Hausmann LRM, Schofield, Woods. Sense of belonging as a predictor of intentions to persist among African American and White first-year college students. Research in Higher Education. 2007 Nov 1; 48(7):803-839.
Center Products

  1. Hausmann LR, Weeks C, Fine MJ, Asch DA. CHERP Policy Brief: Patient perceptions of discrimination in health care settings. 2009 Feb 5; 4(4).
VA Cyberseminars

  1. Hausmann LR, Gao S, Lee ES, Kwoh CK. Racial disparities in the monitoring of patients on chronic opioid therapy [Spotlight on Pain Management Cyberseminar Series]. [Cyberseminar]. 2013 May 7.
Conference Presentations

  1. Hausmann LR, Brandt C, Carroll C, Fenton BT, Ibrahim SA, Becker W, Burgess D, Wandner L, Bair MJ, Goulet JL. Racial and Ethnic Differences in Total Knee Arthroplasty in the Veterans Affairs Healthcare System from 2001 - 2014. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  2. Hausmann LR, Gao S, Canamucio A. Patient racial/ethnic composition and other facility characteristics associated with delivery of patient-centered care in VHA outpatient facilities. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA.
  3. Hall DE, Hausmann LR, Fine MJ. Intervening equitably to eliminate health care disparities. Paper presented at: American Society of Biomechanics Annual Meeting; 2014 Oct 17; San Diego, CA.
  4. Hausmann LR, Parks A, Youk AO, Hannon M, Ibrahim SA, Weiner DK, Gallagher RM. Staying positive with arthritis: impact of a positive activities program on pain and functioning in Veterans with arthritis. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2014 Apr 25; Philadelphia, PA.
  5. Trivedi A, Nsa W, Hausmann LR, Lee J, Ma A, Bratzler D, Baus K, Fine MJ. Trends in the quality of care and racial/ethnic disparities in US hospitals, 2005-2010. Paper presented at: AcademyHealth Annual Research Meeting; 2013 Jun 23; Baltimore, MD.
  6. Fine MJ, Hausmann LR, Lee JS, Nsa W, Trivedi A, Bratzler DW, Auden D, Mor M, Baus K, Larbi FM. National trends in processes and outcomes of care for elderly patients hospitalized for pneumonia. Paper presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 27; Denver, CO.
  7. Lee JS, Nsa W, Hausmann LR, Trivedi AN, Bratzler DW, Auden D, Baus K, Larbi FM, Fine MJ. Associations between processes of care and mortality in a national cohort of elderly patients hospitalized for pneumonia. Paper presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 24; Denver, CO.
  8. Trivedi AN, Nsa W, Hausmann LR, Lee J, Ma A, Bratzler D, Baus K, Larbi F, Fine MJ. Trends in the quality of care and racial/ethnic disparities in US hospitals, 2005-2010. Paper presented at: Society of General Internal Medicine Annual Meeting; 2013 Apr 23; Denver, CO.
  9. Hausmann LR, Youk AO, Parks A. Reduction of bodily pain in response to an online positive activities intervention. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2013 Mar 21; San Francisco, CA.
  10. Hausmann LR, Myaskovsky L, Niyonkuru C, Oyster ML, Switzer GE, Burkitt KH, Fine MJ, Boninger ML. Provider racial bias may be associated with less positive outcomes for patients with spinal cord injury. Poster session presented at: National Institutes of Health Science of Eliminating Health Disparities Annual Summit; 2012 Dec 18; National Harbor, MD.
  11. Hausmann LR, Gao S, Mor MK, Schaefer JH, Fine MJ. Racial and ethnic differences in outpatient experiences in US Veterans Affairs Medical Centers. Paper presented at: National Institutes of Health Science of Eliminating Health Disparities Annual Summit; 2012 Dec 17; National Harbor, MD.
  12. Hausmann LR, Gao S, Lee ES, Kwoh CK. Racial disparities in the monitoring of patients on chronic opioid therapy. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 17; National Harbor, MD.
  13. Myaskovsky L, Hausmann LR. Designing a course to engage clinical scholars in healthcare disparities research. Poster session presented at: Clinical Research and Translational Research in Health Disparities Multidisciplinary Conference and Summit; 2012 Feb 23; San Juan, Puerto Rico.
  14. Hausmann LR, Kwoh CK, Hannon M, Ibrahim SA. Patient race, perceptions of racism in healthcare settings, and physician trust. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 4; Phoenix, AZ.
  15. Hausmann LR, Kressin NR, Hanusa BH, Ibrahim SA. The association of perceived racial discrimination with patients’ healthcare experiences: choice of measure matters. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2010 Apr 10; Seattle, WA.
  16. Hausmann LR, Hannon M, Kresevic D, Hanusa BH, Kwoh CK, Ibrahim SA. Perceived discrimination in health care and its association with patient-provider communication. Poster session presented at: VA HSR&D Career Development Annual Meeting; 2010 Feb 25; San Francisco, CA.
  17. Hausmann LR, Hanusa BH, Geng M, Ibrahim SA. The impact of African American patients’ perceptions of past racial discrimination in healthcare on subsequent patient-provider communication. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2009 Apr 22; Montréal, Canada.
  18. Hausmann L, Hanusa B, Kresevic D, Mor M, Gordon HS, Geng M, Ibrahim S. Race and joint replacement recommendation: the role of preference and doctor-patient communication. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.
  19. Hausmann LRM, Ren D, Sevick MA. Access to chronic illness resources and their relevance to racial differences in glycemic control. Poster session presented at: American Diabetes Association Annual Scientific Session; 2008 Jun 6; San Francisco, CA.
  20. Hausmann LRM, Kresevic D, Cohen PZ, Grant R, Kwoh CK, Mor M, Geng M, Ling BS, Ibrahim SA. Doctor-patient communication and the racial disparity in recommendations for joint replacement. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2008 Apr 9; Pittsburgh, PA.
  21. Hausmann LRM, Kresevic D, Cohen PZ, Grant R, Zickmund SL, Mor M, Geng M, Gordon HS, Ibrahim SA. Patient race and doctor-patient communication in the orthopedic setting. Paper presented at: Society of General Internal Medicine Annual Meeting; 2008 Apr 9; Pittsburgh, PA.
  22. Hausmann LRM, Mor MK, Geng M, Zickmund SL, Ling BS, Kresevic D, Gordon HS, Cohen PZ, Grant R, Ibrahim SA. Race and patient-provider concordance on treatment recommendation for joint replacement. Paper presented at: Leo H. Criep on Patient-Provider Communication Annual Symposium; 2007 Nov 15; Pittsburgh, PA.
  23. Hausmann LRM, Mor M, Geng M, Kresevic D, Cohen PZ, Grant R, Ibrahim A. Perceptions of past racial discrimination in healthcare diminish African American patients' satisfaction with subsequent treatment recommendations. Poster session presented at: Society for Medical Decision Making Annual Meeting; 2007 Oct 21; Pittsburgh, PA.
  24. Hausmann LRM, Mor M, Geng M, Zickmund SL, Ling BS, Kresevic D, Gordon HS, Cohen PZ, Grant R, Ibrahim SA. Race and patient-provider concordance on treatment recommendation for joint replacement. Paper presented at: Society for Medical Decision Making Annual Meeting; 2007 Oct 21; Pittsburgh, PA.


DRA: Health Systems
DRE: Technology Development and Assessment
Keywords: Equity
MeSH Terms: none

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