Yhenneko J. Taylor

Racial differences in PSA screening interval and stage at diagnosis.

ObjectivesThis study examined PSA screening interval of black and white men aged 65 or older and its association with prostate cancer stage at diagnosis.MethodsSEER-Medicare data were examined for 18,067 black and white men diagnosed with prostate cancer between 1994 and 2002. Logistic regression was used to assess the association between race, PSA screening interval, and stage at diagnosis. Analysis also controlled for age, marital status, comorbidity, diagnosis year, geographic region, income, and receipt of surgery.ResultsCompared to whites, blacks diagnosed with prostate cancer were more likely to have had a longer PSA screening interval prior to diagnosis, including a greater likelihood of no pre-diagnosis use of PSA screening. Controlling for PSA screening interval was associated with a reduction in blacks’ relative odds of being diagnosed with advanced (stage III or IV) prostate cancer, to a point that the stage at diagnosis was not statistically different from that of whites (OR=1.12, 95% CI=0.98–1.29). Longer intra-PSA intervals were systematically associated with greater odds of diagnosis with advanced disease.ConclusionsMore frequent or systematic PSA screening may be a pathway to reducing racial differences in prostate cancer stage at diagnosis, and, by extension, mortality.

Patterns in Prostate-Specific Antigen Test Use and Digital Rectal Examinations in the Behavioral Risk Factor Surveillance System, 2002-2006

BACKGROUND Studies have examined prostate-specific antigen (PSA) test and digital rectal examination (DRE) use among men; however, few have examined use of these procedures together over time. This study examined use of the PSA test and DRE among men over time and identified correlates associated with test use for the PSA test only, the DRE only, and both procedures combined. METHODS The Behavioral Risk Factor Surveillance System (BRFSS) collected information on prostate cancer test use among 229,574 men aged 40 or older over 3 years (2002, 2004, and 2006). Patterns of PSA test and DRE use were examined overall and by selected demographic and health-related characteristics. Correlates of recent PSA test and DRE use were determined using logistic regression. RESULTS Overall trends for years 2002-2006 were a significant increase for PSA use only and a significant decrease of PSA and DRE use combined. Having had a recent PSA test (within 2 years) only; a recent DRE only; or both tests varied by sociodemographic and health-related variables, including age, race/ethnicity, marital status, levels of education and income, body mass index, health insurance status, and having a personal doctor or health care provider. CONCLUSION Although major organizations are not in agreement about the efficacy of prostate cancer screening, the PSA test and DRE continue to be utilized regularly by a majority of American men over age 40. PSA test and DRE use in this population provide a basis for addressing issues related to screening.

The effect of hospital and surgeon volume on racial differences in recurrence-free survival after radical prostatectomy.

Objective:This study investigates associations between hospital and surgeon volume, and racial differences in recurrence after surgery for prostate cancer. Methods:Data from the 1991 to 2002 Surveillance, Epidemiology, and End-Results-Medicare database were examined for 962 black and 7387 white men who received surgery for prostate cancer within 6 months of diagnosis during 1993–1999. Cox regression models were used to estimate the relationships between volume (grouped in tertiles), recurrence or death, and race, controlling for age, Gleason grade, and comorbidity score. Results:Prostate cancer recurrence-free survival rates improved with hospital and surgical volume. Black men were more likely to experience recurrence than white men [hazard ratio (HR) = 1.34; 95% confidence interval (CI): 1.20–1.50]. Stratification by hospital volume revealed that racial differences persisted for medium and high volume hospitals, even after covariate adjustments (medium HR = 1.30, 95% CI: 1.04–1.61; high HR = 1.36, 95% CI: 1.07–1.73). Racial differences persisted within medium and high levels of surgeon volume as well (medium HR = 1.43, 95% CI: 1.10–1.85; high HR = 1.57, 95% CI: 1.14–2.16). Conclusions:High hospital and physician volumes were not associated with reduced racial differences in recurrence-free survival after prostate cancer surgery, contrary to expectation. This study suggests that social and behavioral characteristics, and some aspects of access, may play a larger role than organizational or systemic characteristics with regard to recurrence-free survival for this population.

Planning for Action: The Impact of an Asthma Action Plan Decision Support Tool Integrated into an Electronic Health Record (EHR) at a Large Health Care System

Introduction: Asthma is a chronic airway disease that can be difficult to manage, resulting in poor outcomes and high costs. Asthma action plans assist patients with self-management, but provider compliance with this recommendation is limited in part because of guideline complexity. This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. Methods: eAAP development occurred in 4 phases: web-based prototype creation, multidisciplinary team engagement, pilot, and system-wide dissemination. Medical record and hospital billing data compared frequencies of asthma exacerbations before and after eAAP receipt with matched controls. Results: Between December 2012 and September 2014, 5174 patients with asthma (∼10%) received eAAPs. Results showed an association between eAAP receipt and significant reductions in pediatric asthma exacerbations, including 33% lower odds of requiring oral steroids (P < .001), compared with controls. Equivalent adult measures were not statistically significant. Conclusions: This study supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations. We show the feasibility of leveraging technology to provide guideline-based decision support through an eAAP, addressing known challenges of implementation into routine practice.

Discussions about prostate cancer screening between U.S. primary care physicians and their patients.

ObjectiveThis study examined the likelihood that U.S. primary care physicians (PCPs) discuss and recommend prostate cancer screening with their patients and physician-related and practice-related factors associated with this behavior.MethodsWe analyzed data from the 2007–2008 National Survey of Primary Care Physician Practices Regarding Prostate Cancer Screening (N = 1,256), the most recent and comprehensive survey specifically designed to address issues concerning prostate cancer screening and representing nearly 95,000 PCPs. We evaluated the relationship between PCP behavior regarding prostate cancer screening discussions and covariates, including PCP demographic and practice-related factors. Weighted percentages and Chi-square tests were used to compare use of screening discussions by PCP characteristics. Adjusted odds of discussing screening and recommending the PSA test were determined from logistic regression.ResultsEighty percent of PCPs reported that they routinely discuss prostate cancer screening with all of their male patients, and 64.1% of PCPs who discussed screening with any patients reported that they attempted to talk their patients into getting the PSA test. In multivariate analyses, encouraging PSA testing was more likely among non-Hispanic black PCPs (OR = 2.80, 95% CI [1.88, 4.16]), PCPs serving 100 or more patients per week (OR = 2.16, 95% CI [1.38, 3.37]), and PCPs spending longer hours per week in direct patient care (31–40 hours: OR = 1.90, 95% CI [1.13, 3.20]; 41 or more hours: OR = 2.09, 95% CI [1.12, 3.88]), compared to their referents. PCPs in multi-specialty group practice were more likely to remain neutral or discourage PSA testing compared to PCPs in solo practice.ConclusionsBoth individual and practice-related factors of PCPs were associated with the use of prostate cancer screening discussions by U.S. PCPs. Results from this study may prove valuable to researchers and clinicians and help guide the development and implementation of future prostate cancer screening interventions in the U.S.

Trends in Prostate-Specific Antigen Test Use, 2000–2005

Objective. This study examined prostate-specific antigen (PSA) test use among men and identified sociodemographic and health-related characteristics associated with its use over time. Methods. The National Health Interview Survey collected information on PSA test use among 16,058 men ≥40 years of age in 2000 and 2005. We examined two outcomes: (7) having had a recent (within two years) screening PSA test and (2) having had three or more PSA tests in the past five years (to indicate frequent use). Results. Marital status, family history of prostate cancer, and having seen a doctor in the past year differed overtime in the unadjusted model. In the adjusted model, recent PSA screening decreased from 2000 to 2005 for single, never-married men, but increased for men with chronic diseases. Frequent PSA test use increased for men with a family history of prostate cancer, men with chronic diseases, and men who had seen a physician in the past year. Significant correlates of higher recent PSA test use included being older, married, and of black race/ethnicity; having higher levels of education and income, health-care coverage, and a usual place of health care; and increased comorbidity. Conclusion. Major organizations are not in agreement about the efficacy of prostate cancer screening; however, men ≥40 years of age continue to use the PSA test. Both recent screening and frequent testing showed variability during the study period and may have implications for the ongoing randomized clinical trials that are expected to clarify whether early detection of prostate cancer with PSA testing increases survival.

Measuring the Impact and Outcomes of Maternal Child Health Federal Programs

Improving maternal and child health is a key objective of the United Nations’ Millennium Development Goals and the Healthy People goals for improving the health of Americans. Government initiatives are important particularly for reducing disparities that affect disadvantaged populations. Head Start, Healthy Start, WIC and Medicaid are four federal programs that target disparities in maternal and child health outcomes. This paper reviews recent evaluations of these programs to identify outcomes assessed and opportunities for further evaluation of these programs. We conducted a review of recent evaluation studies assessing the impact of four maternal and child health programs on a health or healthcare outcome. Sources for published literature included the PubMed, Academic Search Complete, CINAHL and PsycInfo databases. Titles and abstracts of studies were examined to determine if they met inclusion criteria. Included studies were categorized by type of outcome examined. Twenty peer-reviewed studies published between January 2006 and June 2011 met inclusion criteria. The majority of studies examined infant outcomes (11), followed by breastfeeding/nutrition (4), maternal health (3), and unintended pregnancy (2). Measures used were consistent across studies; however, findings on the impact of programs were mixed reflecting differences in selection of comparison group, data source and statistical methods. The impact of maternal and child health programs may vary by setting and population served, but inconclusive findings remain. Health service researchers can build upon current evaluations to increase our understanding of what works, help target resources, and improve evaluation of programs in the future.

Participating in Research: Attitudes within the African American Church

We assessed associations between pastor and congregant characteristics and congregant attitudes about research participation among African American churches. Respondents shared their attitudes regarding how willing, ready, and confident they were about research participation. The outcome measure, the index of research preparedness, summed responses across the domains of willingness, readiness, and confidence. Pastor age and pastor educational attainment were independently associated with a congregants’ higher index of research preparedness. Young and educated pastors were significantly associated with congregant attitudes about participation preparedness, a finding that highlights the importance of the pastor regarding congregant research participation decisions.

Examining Characteristics of Congregation Members Willing to Attend Health Promotion in African American Churches

Background. Although churches are an important partner for improving health within the African American community, it is not known how congregants are best reached by health promotion activities and thus how best to target members in recruitment. This study examined how characteristics of churches and congregants’ beliefs and interests in faith-based health promotion related to their willingness to attend church-based health promotion activities. Method. We surveyed adult congregants (n = 1,204) of 11 predominately African American churches in North Carolina. Surveys collected data within four domains: demographics (age, sex, education), behavioral (church attendance, respondent food choices, and physical activity), cognitive (church-based health promotion belief, Bible-based healthy living interest, healthy living resource interest), or environmental (family health, church travel distance, church health ministry activity, church members’ food choices). Analyses used a dichotomous outcome, interest in attending programs offered by the health ministry. Domain-specific models were constructed. Logistic generalized estimating equations adjusted for clustering. Results. Of the 1,204 congregants, 72% were female, 57% were 50 years or older, 84% had a high school education or more, and 77% had a chronic health condition. In bivariate analyses and in models adjusting for all four domains, cognitive factors had the highest odds of willingness to attend. Conclusion. Congregants’ belief in the church’s role in health promotion and their desire to learn about healthy behaviors highlight the role of the African American church as a partner in addressing health disparities and the need to capitalize on this expectation through stronger partnerships between medical and faith communities.

Physician-Patient Discussions With African American Men About Prostate Cancer Screening

Prostate cancer is the second leading cancer killer in men. Men in general and African American men in particular face crucial decisions regarding prostate cancer screening and perhaps treatment for this disease. Major health organizations agree that men should discuss prostate cancer screening with their physicians or other health care professionals. The purpose of the study was to examine sociodemographic and other correlates of physician-patient discussions regarding the advantages and disadvantages of the prostate-specific antigen (PSA) test among African American men aged 40 or older. A majority of African American men reported having discussed the advantages and disadvantages of prostate cancer screening and/or testing with their physicians before ordering it, and physician-patient discussions about the PSA test were associated with increased screening in African American men. Inasmuch as African American men have greater prostate cancer incidence and mortality over other groups, future attempts should be made to find meaningful correlates of PSA screening and test use to help reduce the burden of this disease.