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"https://www.academia.edu/login?post_login_redirect_url=https%3A%2F%2Fwww.academia.edu%2F16214960%2FPatient_Reported_Racial_Ethnic_Healthcare_Provider_Discrimination_and_Medication_Intensification_in_the_Diabetes_Study_of_Northern_California_DISTANCE_%3Fshow_translation%3Dtrue"; window.loswp.previewableAttachments = [{"id":42632629,"identifier":"Attachment_42632629","shouldShowBulkDownload":false}]; window.loswp.shouldDetectTimezone = true; window.loswp.shouldShowBulkDownload = true; window.loswp.showSignupCaptcha = false window.loswp.willEdgeCache = false; window.loswp.work = {"work":{"id":16214960,"created_at":"2015-09-26T17:36:24.056-07:00","from_world_paper_id":142304770,"updated_at":"2024-11-15T14:57:50.130-08:00","_data":{"grobid_abstract":"BACKGROUND: Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE: To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification. RESEARCH DESIGN AND PARTICIPANTS: Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005-2006, including both survey and medical record data. MAIN MEASURES: Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c≥9.0%; systolic BP≥140 mmHg or diastolic BP≥90 mmHg; low-density lipoprotein (LDL)≥130 mg/dl). KEY RESULTS: Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR=0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR=1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR=1.06 (95% CI: 0.69, 1.61) for hypertension, and RR=1.08 (95% CI: 0.88, 1.33) for the composite cohort]. CONCLUSIONS: We found no evidence that patientreported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patientcenteredness, communication).","publication_date":"2011,,","publication_name":"Journal of General Internal Medicine","grobid_abstract_attachment_id":"42632629"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)","broadcastable":false,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [35319673]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":42632629,"attachmentType":"pdf"}"><img alt="First page of “Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/42632629/mini_magick20190217-8883-h0tfsx.png?1550424857" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="35319673" href="https://independent.academia.edu/ClarenceSpigner"><img alt="Profile image of Clarence Spigner" class="ds-work-card--author-avatar" src="//a.academia-assets.com/images/s65_no_pic.png" />Clarence Spigner</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2011, Journal of General Internal Medicine</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">7 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 16214960; const worksViewsPath = "/v0/works/views?subdomain_param=api&work_ids%5B%5D=16214960"; const getWorkViews = async (workId) => { const response = await fetch(worksViewsPath); if (!response.ok) { throw new Error('Failed to load work views'); } const data = await response.json(); return data.views[workId]; }; // Get the view count for the work - we send this immediately rather than waiting for // the DOM to load, so it can be available as soon as possible (but without holding up // the backend or other resource requests, because it's a bit expensive and not critical). const viewCount = await getWorkViews(workId); const updateViewCount = (viewCount) => { try { const viewCountNumber = parseInt(viewCount, 10); if (viewCountNumber === 0) { // Remove the whole views element if there are zero views. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); return; } const commaizedViewCount = viewCountNumber.toLocaleString(); const viewCountBody = document.getElementById('work-metadata-view-count'); if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">BACKGROUND: Racial/ethnic minority patients are more likely to report experiences with discrimination in the healthcare setting, potentially leading to reduced access to appropriate care; however, few studies evaluate reports of discrimination with objectively measured quality of care indicators. OBJECTIVE: To evaluate whether patient-reported racial/ethnic discrimination by healthcare providers was associated with evidence of poorer quality care measured by medication intensification. RESEARCH DESIGN AND PARTICIPANTS: Baseline data from the Diabetes Study of Northern California (DISTANCE), a random, race-stratified sample from the Kaiser Permanente Diabetes Registry from 2005-2006, including both survey and medical record data. MAIN MEASURES: Self-reported healthcare provider discrimination (from survey data) and medication intensification (from electronic prescription records) for poorly controlled diabetes patients (A1c≥9.0%; systolic BP≥140 mmHg or diastolic BP≥90 mmHg; low-density lipoprotein (LDL)≥130 mg/dl). KEY RESULTS: Of 10,409 eligible patients, 21% had hyperglycemia, 14% had hyperlipidemia, and 32% had hypertension. Of those with hyperglycemia, 59% had their medications intensified, along with 40% with hyperlipidemia, 33% with hypertension, and 47% in poor control of any risk factor. In adjusted log-binomial GEE models, discrimination was not associated with medication intensification [RR=0.96 (95% CI: 0.74, 1.24) for hyperglycemia, RR=1.23 (95% CI: 0.93, 1.63) for hyperlipidemia, RR=1.06 (95% CI: 0.69, 1.61) for hypertension, and RR=1.08 (95% CI: 0.88, 1.33) for the composite cohort]. CONCLUSIONS: We found no evidence that patientreported healthcare discrimination was associated with less medication intensification. While not associated with this technical aspect of care, discrimination could still be associated with other aspects of care (e.g., patientcenteredness, communication).</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":42632629,"attachmentType":"pdf","workUrl":"https://www.academia.edu/16214960/Patient_Reported_Racial_Ethnic_Healthcare_Provider_Discrimination_and_Medication_Intensification_in_the_Diabetes_Study_of_Northern_California_DISTANCE_"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":42632629,"attachmentType":"pdf","workUrl":"https://www.academia.edu/16214960/Patient_Reported_Racial_Ethnic_Healthcare_Provider_Discrimination_and_Medication_Intensification_in_the_Diabetes_Study_of_Northern_California_DISTANCE_"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas" data-impression-entity-id="16214960" data-impression-entity-type="2" data-impression-source="signup-banner"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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We examined survey data from the Diabetes Study of Northern California (DISTANCE), a race-stratified sample of Kaiser diabetes patients. Respondents reported perceived discrimination, and regression models examined socioeconomic, acculturative, and psychosocial correlates. Subjects (n=17,795) included 20% Blacks, 23% Latinos, 13% East Asians, 11% Filipinos, and 27% Whites. Three percent and 20% reported health care and general discrimination. Health care discrimination was more frequently reported by minorities (ORs ranging from 2.0 to 2.9 compared with Whites) and those with poorer health literacy (OR=1.10, 95% CI: 1.04-1.16), limited English proficiency (OR=1.91, 95% CI: 1.32-2.78), and depression (OR=1.53, 95% CI: 1.10-2.13). In addition to race/ethnicity, health literacy and English proficiency may be bases of discrimination. Evaluation is needed to determine whether patients are treated differently o...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Correlates of patient-reported racial/ethnic health care discrimination in the Diabetes Study of Northern California (DISTANCE)","attachmentId":42632619,"attachmentType":"pdf","work_url":"https://www.academia.edu/16214981/Correlates_of_patient_reported_racial_ethnic_health_care_discrimination_in_the_Diabetes_Study_of_Northern_California_DISTANCE_","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/16214981/Correlates_of_patient_reported_racial_ethnic_health_care_discrimination_in_the_Diabetes_Study_of_Northern_California_DISTANCE_"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="16214968" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/16214968/Provider_factors_and_patient_reported_healthcare_discrimination_in_the_Diabetes_Study_of_California_DISTANCE_">Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="35319673" href="https://independent.academia.edu/ClarenceSpigner">Clarence Spigner</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Patient Education and Counseling, 2011</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Provider factors and patient-reported healthcare discrimination in the Diabetes Study of California (DISTANCE)","attachmentId":42632631,"attachmentType":"pdf","work_url":"https://www.academia.edu/16214968/Provider_factors_and_patient_reported_healthcare_discrimination_in_the_Diabetes_Study_of_California_DISTANCE_","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/16214968/Provider_factors_and_patient_reported_healthcare_discrimination_in_the_Diabetes_Study_of_California_DISTANCE_"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="30112700" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/30112700/The_Effects_of_Perceived_Discrimination_on_Diabetes_Management">The Effects of Perceived Discrimination on Diabetes Management</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32617402" href="https://independent.academia.edu/GriffithDerek">Derek Griffith</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of Health Care for the Poor and Underserved, 2008</p><p class="ds-related-work--abstract ds2-5-body-sm">We investigated whether self-reported racial/ethnic and gender discrimination were associated with lower rates of diabetes management. Analyses focused on 524 respondents with diabetes from the 2001 Commonwealth Health Care Quality Survey. Probit models estimated the marginal effect of self-reported racial/ethnic and gender discrimination on diabetes management, adjusting for racial/ethnic and gender concordance of the patient and physician, as well as a variety of health and sociodemographic indicators. Self-reported racial/ethnic discrimination was associated with a roughly 50% lower marginal probability of receiving a hemoglobin A1c test, foot exam, and blood pressure exam, when accounting for racial/ethnic and gender physician-patient concordance and other factors. Self-reported gender discrimination was associated with 22% lower marginal probability of conducting a hemoglobin test but not associated with the other management indicators. Evidence from this study suggests that racial/ethnic discrimination is an important barrier to diabetes management.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The Effects of Perceived Discrimination on Diabetes Management","attachmentId":50575549,"attachmentType":"pdf","work_url":"https://www.academia.edu/30112700/The_Effects_of_Perceived_Discrimination_on_Diabetes_Management","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/30112700/The_Effects_of_Perceived_Discrimination_on_Diabetes_Management"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="4787189" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/4787189/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_in_a_Nationally_Representative_Sample">Racial and Ethnic Disparities in the Quality of Diabetes Care in a Nationally Representative Sample</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="6174955" href="https://trick-computer.academia.edu/PatrickRichard">Patrick Richard</a></div><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Racial and Ethnic Disparities in the Quality of Diabetes Care in a Nationally Representative Sample","attachmentId":32090446,"attachmentType":"pdf","work_url":"https://www.academia.edu/4787189/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_in_a_Nationally_Representative_Sample","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/4787189/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_in_a_Nationally_Representative_Sample"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="6124966" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/6124966/Primary_care_Clinician_Perceptions_of_Racial_Disparities_in_Diabetes_Care">Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="9279572" href="https://independent.academia.edu/DanaSafran">Dana Safran</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of General Internal Medicine, 2008</p><p class="ds-related-work--abstract ds2-5-body-sm">Background Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. Objective The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. Design The design of the study is through a survey of primary-care clinicians (response rate = 86%). Participants The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. Measurements and Main Results We identified sociodemographic characteristics of each clinician’s diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients’ race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients’ race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2–65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5–57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). Conclusions Most primary-care clinicians support the collection of data on patients’ race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care","attachmentId":49008410,"attachmentType":"pdf","work_url":"https://www.academia.edu/6124966/Primary_care_Clinician_Perceptions_of_Racial_Disparities_in_Diabetes_Care","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/6124966/Primary_care_Clinician_Perceptions_of_Racial_Disparities_in_Diabetes_Care"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="50025399" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/50025399/Race_Ethnicity_Socioeconomic_Position_and_Quality_of_Care_for_Adults_With_Diabetes_Enrolled_in_Managed_Care_The_Translating_Research_Into_Action_for_Diabetes_TRIAD_study">Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care: The Translating Research Into Action for Diabetes (TRIAD) study</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="45028606" href="https://independent.academia.edu/AKarter">A Karter</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Diabetes Care, 2005</p><p class="ds-related-work--abstract ds2-5-body-sm">OBJECTIVE-To examine racial/ethnic and socioeconomic variation in diabetes care in managed-care settings. RESEARCH DESIGN AND METHODS-We studied 7,456 adults enrolled in health plans participating in the Translating Research Into Action for Diabetes study, a six-center cohort study of diabetes in managed care. Cross-sectional analyses using hierarchical regression models assessed processes of care (HbA 1c [A1C], lipid, and proteinuria assessment; foot and dilated eye examinations; use or advice to use aspirin; and influenza vaccination) and intermediate health outcomes (A1C, LDL, and blood pressure control). RESULTS-Most quality indicators and intermediate outcomes were comparable across race/ethnicity and socioeconomic position (SEP). Latinos and Asians/Pacific Islanders had similar or better processes and intermediate outcomes than whites with the exception of slightly higher A1C levels. Compared with whites, African Americans had lower rates of A1C and LDL measurement and influenza vaccination, higher rates of foot and dilated eye examinations, and the poorest blood pressure and lipid control. The main SEP difference was lower rates of dilated eye examinations among poorer and less educated individuals. In almost all instances, racial/ ethnic minorities or low SEP participants with poor glycemic, blood pressure, and lipid control received similar or more appropriate intensification of therapy relative to whites or those with higher SEP. CONCLUSIONS-In these managed-care settings, minority race/ethnicity was not consistently associated with worse processes or outcomes, and not all differences favored whites. The only notable SEP disparity was in rates of dilated eye examinations. Social disparities in health may be reduced in managed-care settings.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Race, Ethnicity, Socioeconomic Position, and Quality of Care for Adults With Diabetes Enrolled in Managed Care: The Translating Research Into Action for Diabetes (TRIAD) study","attachmentId":68163863,"attachmentType":"pdf","work_url":"https://www.academia.edu/50025399/Race_Ethnicity_Socioeconomic_Position_and_Quality_of_Care_for_Adults_With_Diabetes_Enrolled_in_Managed_Care_The_Translating_Research_Into_Action_for_Diabetes_TRIAD_study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/50025399/Race_Ethnicity_Socioeconomic_Position_and_Quality_of_Care_for_Adults_With_Diabetes_Enrolled_in_Managed_Care_The_Translating_Research_Into_Action_for_Diabetes_TRIAD_study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="30683495" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/30683495/Racial_Ethnic_Discrimination_in_Health_Care_Impact_on_Perceived_Quality_of_Care">Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="58431738" href="https://independent.academia.edu/DaraSorkin">Dara Sorkin</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Journal of General Internal Medicine, 2010</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Racial/Ethnic Discrimination in Health Care: Impact on Perceived Quality of Care","attachmentId":51124463,"attachmentType":"pdf","work_url":"https://www.academia.edu/30683495/Racial_Ethnic_Discrimination_in_Health_Care_Impact_on_Perceived_Quality_of_Care","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/30683495/Racial_Ethnic_Discrimination_in_Health_Care_Impact_on_Perceived_Quality_of_Care"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="60585366" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/60585366/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_for_the_Elderly_in_a_Nationally_Representative_Sample">Racial and Ethnic Disparities in the Quality of Diabetes Care for the Elderly in a Nationally Representative Sample</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="176918350" href="https://independent.academia.edu/MustafaYounis5">Mustafa Younis</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Ageing International, 2012</p><p class="ds-related-work--abstract ds2-5-body-sm">Minority elderly patients with diabetes receive lower quality of care based on an array of quality measures across various health care settings. However, the documentation of racial/ethnic disparities in quality of care for elderly patients with diabestes relies on a few major data sets such as claims data from Medicare beneficiaries, the Veterans Health Administration (VHA) databases, or the Health Plan Employer Data and Information Set (HEDIS) databases. The current study examines if racial/ethnic disparities in the quality of diabetes care found among elderly patients have begun to abate by using data from a nationally representative survey not frequently used in the literature. Using pooled data from the 2002-2007 Medical Expenditure Panel Survey, we found that elderly black patients with diabetes were less likely to receive appropriate quality of care as reported by patients, or eye examination and more likely to receive a foot examination compared</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Racial and Ethnic Disparities in the Quality of Diabetes Care for the Elderly in a Nationally Representative Sample","attachmentId":73963850,"attachmentType":"pdf","work_url":"https://www.academia.edu/60585366/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_for_the_Elderly_in_a_Nationally_Representative_Sample","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/60585366/Racial_and_Ethnic_Disparities_in_the_Quality_of_Diabetes_Care_for_the_Elderly_in_a_Nationally_Representative_Sample"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="19251644" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/19251644/The_Relationship_Between_Perceived_Discrimination_and_Patient_Experiences_With_Health_Care">The Relationship Between Perceived Discrimination and Patient Experiences With Health Care</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="39492341" href="https://independent.academia.edu/ThomasBryant5">Thomas Bryant</a></div><p class="ds-related-work--abstract ds2-5-body-sm">Background: Prior studies have shown that racial/ethnic minorities have lower Consumer Assessments of Healthcare Providers and Systems (CAHPS) scores. Perceived discrimination may mediate the relationship between race/ethnicity and patient experiences with care. Objective: To examine the relationship between perceived discrimination based on race/ethnicity and Medicaid insurance and CAHPS reports and ratings of care. Methods: The study analyzed 2007 survey data from 1509 Florida Medicaid beneficiaries. CAHPS reports (getting needed care, timeliness of care, communication with doctor, and health plan customer service) and ratings (personal doctor, specialist care, overall health care, and health plan) of care were the primary outcome variables. Patient perceptions of discrimination based on their race/ethnicity and having Medicaid insurance were the primary independent variables. Regression analysis modeled the effect of perceptions of discrimination on CAHPS reports and ratings controlling for age, sex, education, self-rated health status, race/ethnicity, survey language, and fee-for-service enrollment. SEs were corrected for correlation within plans. Results: Medicaid beneficiaries reporting discrimination based on race/ethnicity had lower CAHPS scores, ranging from 15 points lower (on a 0–100 scale) for getting needed care to 6 points lower for specialist rating, compared with those who never experienced discrimination. Similar results were obtained for perceived discrimination based on Medicaid insurance. Conclusions: Perceptions of discrimination based on race/ethnicity and Medicaid insurance are prevalent and are associated with substantially lower CAHPS reports and ratings of care. Practices must develop and implement strategies to reduce perceived discrimination among patients.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"The Relationship Between Perceived Discrimination and Patient Experiences With Health Care","attachmentId":40516402,"attachmentType":"pdf","work_url":"https://www.academia.edu/19251644/The_Relationship_Between_Perceived_Discrimination_and_Patient_Experiences_With_Health_Care","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/19251644/The_Relationship_Between_Perceived_Discrimination_and_Patient_Experiences_With_Health_Care"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="67655933" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/67655933/Racial_Discrimination_in_Health_Care_Is_Associated_with_Worse_Glycemic_Control_among_Black_Men_but_Not_Black_Women_with_Type_2_Diabetes">Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="67602807" href="https://cdrewu.academia.edu/ShervinAssari">Shervin Assari</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Frontiers in Public Health</p><p class="ds-related-work--abstract ds2-5-body-sm">Background: A growing body of research suggests that racial discrimination may affect the health of Black men and Black women differently. aims: This study examined Black patients with diabetes mellitus (DM) in order to test gender differences in (1) levels of perceived racial discrimination in health care and (2) how perceived discrimination relates to glycemic control. Methods: A total of 163 Black patients with type 2 DM (78 women and 85 men) provided data on demographics (age and gender), socioeconomic status, perceived racial discrimination in health care, self-rated health, and hemoglobin A1c (HbA1c). Data were analyzed using linear regression. results: Black men reported more racial discrimination in health care than Black women. Although racial discrimination in health care was not significantly associated with HbA1c in the pooled sample (b = 0.20, 95% CI = −0.41 −0.80), gender-stratified analysis indicated an association between perceived discrimination and higher HbA1c levels for Black men (b = 0.86, 95% confidence intervals (CI) = 0.01-1.73) but not Black women (b = −0.31, 95% CI = −1.17 to −0.54). conclusion: Perceived racial discrimination in diabetes care may be more salient for glycemic control of Black men than Black women. Scholars and clinicians should take gender into account when considering the impacts of race-related discrimination experiences on health outcomes. Policies should reduce racial discrimination in the health care.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes","attachmentId":78395737,"attachmentType":"pdf","work_url":"https://www.academia.edu/67655933/Racial_Discrimination_in_Health_Care_Is_Associated_with_Worse_Glycemic_Control_among_Black_Men_but_Not_Black_Women_with_Type_2_Diabetes","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/67655933/Racial_Discrimination_in_Health_Care_Is_Associated_with_Worse_Glycemic_Control_among_Black_Men_but_Not_Black_Women_with_Type_2_Diabetes"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":42632629,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":42632629,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_42632629" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. You can download the paper by clicking the button above.</p></div></div></div></div><div class="ds-sidebar--container js-work-sidebar"><div class="ds-related-content--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="0" data-entity-id="6124982" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/6124982/Physician_Performance_and_Racial_Disparities_in_Diabetes_Mellitus_Care">Physician Performance and Racial Disparities in Diabetes Mellitus Care</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="9279572" href="https://independent.academia.edu/DanaSafran">Dana Safran</a></div><p class="ds-related-work--metadata ds2-5-body-xs">2008</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Physician Performance and Racial Disparities in Diabetes Mellitus Care","attachmentId":49008485,"attachmentType":"pdf","work_url":"https://www.academia.edu/6124982/Physician_Performance_and_Racial_Disparities_in_Diabetes_Mellitus_Care","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/6124982/Physician_Performance_and_Racial_Disparities_in_Diabetes_Mellitus_Care"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="1" data-entity-id="13265854" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/13265854/Disparities_in_diabetes_care_role_of_the_patients_socio_demographic_characteristics">Disparities in diabetes care: role of the patient's socio-demographic characteristics</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="32522917" href="https://independent.academia.edu/EhudKokia">Ehud Kokia</a></div><p class="ds-related-work--metadata ds2-5-body-xs">BMC Public Health, 2010</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Disparities in diabetes care: role of the patient's socio-demographic characteristics","attachmentId":45532418,"attachmentType":"pdf","work_url":"https://www.academia.edu/13265854/Disparities_in_diabetes_care_role_of_the_patients_socio_demographic_characteristics","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/13265854/Disparities_in_diabetes_care_role_of_the_patients_socio_demographic_characteristics"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="2" data-entity-id="41198024" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/41198024/Measuring_Racial_Disparities_in_the_Quality_of_Ambulatory_Diabetes_Care">Measuring Racial Disparities in the Quality of Ambulatory Diabetes Care</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="33263052" href="https://independent.academia.edu/FisherElliott">Elliott Fisher</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Medical Care, 2010</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Measuring Racial Disparities in the Quality of Ambulatory Diabetes Care","attachmentId":61437877,"attachmentType":"pdf","work_url":"https://www.academia.edu/41198024/Measuring_Racial_Disparities_in_the_Quality_of_Ambulatory_Diabetes_Care","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/41198024/Measuring_Racial_Disparities_in_the_Quality_of_Ambulatory_Diabetes_Care"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="3" data-entity-id="72409616" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/72409616/Testing_for_Statistical_Discrimination_in_Health_Care">Testing for Statistical Discrimination in Health Care</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm 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