Debra J. Pérez

The Role of Patient Activation on Patient–Provider Communication and Quality of Care for US and Foreign Born Latino Patients

ABSTRACTBACKGROUNDPrevious research has shown positive effects of patient activation on healthcare outcomes, but there is practically no information on the generalization of these findings for Latino patients. Little data are available on whether patient activation is associated with healthcare outcomes for Latino patients and whether activation varies by language proficiency and nativity status.OBJECTIVEWe examined the levels of activation by characteristics of Latino patients (e.g. nativity, language, health status). We investigated whether patient activation relates to the quality of care received and enhanced doctor–patient communication for Latino patients.DESIGNWe conducted analyses of 1,067 US born and foreign born Latinos who participated in the second wave of the PEW/RWJF Hispanic Healthcare Survey during 2008.PARTICIPANTSParticipants were self-identified Latinos (18+) with a doctor visit, living in the contiguous United States who could be contacted by telephone.RESULTSUS born Latinos had significantly (P < 0.001) greater patient activation scores than foreign born Latinos (75 versus 70). Latinos classified as bilingual and those reporting excellent health evidenced higher mean activation scores as compared to Spanish-speaking Latinos and those reporting fair or poor health. After adjusting for demographics, health status, other language and service use factors, patient activation was strongly associated with self-reported quality of care and better doctor–patient communication among both US and foreign born Latino respondents.CONCLUSIONSInterventions that augment patient activation could increase quality of care and improved patient–provider communication, potentially reducing health care disparities for Latinos.

Perceived Discrimination and Self-Reported Quality of Care Among Latinos in the United States

ABSTRACTBACKGROUNDGiven the persistence of health and health-care disparities among Latinos in the United States and evidence that discrimination affects health and health care, an investigation of the relationship between perceived discrimination and quality of health care among Latinos is warranted.OBJECTIVETo examine the relationship of perceived discrimination (in general and in regard to doctors and medical personnel) with self-reported quality of health care and doctor-patient communication in a nationally representative Latino population sample.PARTICIPANTSParticipants were 1,067 Latino adults aged ≥18 years living in the US selected via random-digit dialing. Telephone interviews were conducted in 2008 during Wave 2 of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey.RESULTSUS-born Latinos were twice as likely to report general discrimination as foreign born: 0.32 SD versus −0.23 SD (P < 0.001) on the Detroit Area Survey (DAS) discrimination scale. Higher DAS discrimination was associated with lower self-reported quality of care in US-born Latinos [OR = 0.5; 95% CI (0.3, 0.9); P = 0.009]. For foreign-born Latinos, report of any doctor or medical staff discrimination was associated with lower quality of care [OR = 0.5; 95% CI (0.3, 0.9); P = 0.03], but the DAS was not. For US-born Latinos, doctor discrimination and higher DAS were jointly associated with worse doctor-patient communication. For foreign-born Latinos, the effect of discrimination on doctor-patient communication was significantly smaller than that observed in US-born Latinos.CONCLUSIONSGiven the association between perceived discrimination and quality of care, strategies to address discrimination in health-care settings may lead to improved patient satisfaction with care and possibly to improved treatment outcomes.

Disparities In Physician Care: Experiences And Perceptions Of A Multi-Ethnic America

This 2007 Harvard School of Public Health/Robert Wood Johnson Foundation survey of 4,334 randomly selected U.S. adults compared perceptions of the quality of physician care among fourteen racial and ethnic groups with those of whites. On each measure examined, at least five and as many as eleven subgroups perceived their care to be significantly worse than care for whites. In many instances, subgroups were at least fifteen percentage points more negative than whites. This was true for Central/South Americans, Chinese Americans, and Korean Americans on five of seven measures. Many of the differences remained after socioeconomic characteristics and language skills were controlled for.

Evaluating Interventions To Reduce Health Care Disparities: An RWJF Program

The Robert Wood Johnson Foundations Finding Answers: Disparities Research for Change program funds evaluation of interventions to reduce racial and ethnic disparities in cardiovascular disease, depression, and diabetes. Of the 177 applications received in 2006, the most prevalent proposed interventions were patient or provider education (57 percent), community health workers (25 percent), case management (24 percent), integrated health care (24 percent), and cultural modification (24 percent). Policy interventions, including pay-for-performance (P4P) incentives, were lacking. The eleven grantees target patients, providers, patient-provider communication, health care organizations, and communities in innovative ways. We identify important future research questions.

New public health services and systems research agenda: directions for the next decade.

or years we have known the value of assessing the delivery and effectiveness of individual clinical ser- vices and how factors such as structure, organiza- tion, and finance influence the quality and quantity of clinical care. There is a comparable field in public health called public health services and systems research (PHSSR) that studies system-level factors and their asso- ciation to public health delivery and the health of popu- lations. Mays and colleagues 1 have defined public health services and systems research as a field of study that examines the organization, finance, and delivery of public health services in communities and the impact of these services on public health. Two more recent efforts 2,3 have focused on expanding and further enhancing that early definition. Scutchfield et al. 2 suggested that PHSSR would benefit from an en-

Public Health Systems and Services Research: Dataset Development, Dissemination, and Use.

Public health systems and services research (PHSSR) is defined as “a field of study that examines the organization, financing, and delivery of public health services within communities and the impact of those services.” PHSSR is a relatively young field and suffers from a paucity of research resources. In this article, we describe the development and utility of a data resource, housed on the Health Services and Sciences Research Resources website maintained by the National Library of Medicine, which provides easy access to instruments, indices, and datasets that are relevant to PHSSR researchers. We also investigate efforts to promote the use and dissemination of these data resources, including the awarding of research grants and the organization of a PHSSR conference.

The Perspectives of Six Latino Heritage Groups About Their Health Care

The Latino population in the US is projected to grow substantially in the years ahead. Although often referred to as a single group, Latinos are not homogeneous. This article, based mainly on a national telephone survey of 1,478 Latino adults, examines the perspectives of six Latino heritage groups on the health care issues they face. The six groups differ in their reported health care experiences in: the types facilities they use in getting medical care, their ratings of the quality of care they receive, their experiences with discrimination in getting quality care, the level of confidence they have in being able to pay for a major illness. One thing the heritage groups agree on is that diabetes is the biggest health problem facing their families. Community health leaders, particularly at the state level, need to focus on the specific Latino groups in their state or area and their unique situations.

The Economic Lives of Latinos in the United States

Rarely do we have a picture of who Latinos are and how they live in the United States. Yet by 2060 the proportion of the U.S. population that is Latino will double, to more than 30 percent. These researchers conducted a survey of a diverse group of Latinos to find out how they live and what their fears and aspirations are.