for Spinal Cord Injury Larissa Myaskovsky PhD Associate Professor of Medicine Psychiatry and Clinical and Translational Science University of Pittsburgh School of Medicine and VA Pittsburgh Healthcare System ID: 1047801
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1. The Influence of Race, Cultural, and Psychosocial Factors on Disparities in Processes and Outcomes of Care for Spinal Cord InjuryLarissa Myaskovsky, PhDAssociate Professor of Medicine, Psychiatry and Clinical and Translational ScienceUniversity of Pittsburgh School of MedicineandVA Pittsburgh Healthcare System
2. Collaborators and Research TeamMichael L. Boninger, MDKelly H. Burkitt, PhDMichael J. Fine, MDShasha Gao, PhDDavid Gater, MDSam Phillips, PhDAnn Spungen, PhDGalen Switzer, PhDKellee BornemannJemy DelikatDevra Greenwald, MPHJewel MooreKel MorinMichelle Oyster, MSDebbie Wetzler
3. Funding SourcesDepartment of EducationNational Institute of Disability and Rehab Research (NIDRR)VACHERP Pilot StudyRehabilitation Research and Development Division (VA RR&D)
4. Presentation TopicsA health service research perspectiveWhy are health services researchers interested in Spinal Cord Injury (SCI)?Brief epidemiology of SCIRace and culture in SCIResearch findings (hot off the presses!)
5. Health Services ResearchSocial FactorsFinancing SystemsOrganizational Structures and ProcessesHealth TechnologiesPersonal BehaviorAccess to healthcareQuality and cost of healthcareHealth and well-being
6. CHERP Model to Advance Health Equity Research DetectingDefine health disparitiesDefine vulnerable populationsMeasure disparities in vulnerable populationsConsider selection effects and confounding factors Understanding Identify determinants of health disparities at the following levels:Patient/individualProviderClinical encounterHealthcare system ReducingInterveneEvaluateTranslate anddisseminateChange policyFirst GenerationSecond GenerationThird GenerationKilbourne et al, Am J Public Health 2006
7. Conceptualizing Disparities in Health and Health CareHealthcare DisparitiesProcesses of careStructure of careHealth Disparities Medical Complications MortalityFunctional status Quality of lifeProviderKnowledgeAttitudesCommunicationPatientDemographicsBiology/GenesPreferencesSystemAccessibilityOrganizationQualityEnvironmentGeography Poverty Segregation Social norms
8. Why are Health Services Researchers Interested in Spinal Cord Injury?High incidence and prevalence rate12,000 new cases each year (incidence)Prevalence of SCI in 2013 = 273,000 (range = 238,000 – 332,000)www.nscisc.uab.edu
9. Why are Health Services Researchers Interested in Spinal Cord Injury?High incidence and prevalence rateChanging demographics
10. SCI Demographics Over Timewww.nscisc.uab.edu
11. Why are Health Services Researchers Interested in Spinal Cord Injury?High incidence and prevalence rateChanging demographicsExemplar of life-long, team-based, patient-focused care
12. Life-Long Care in Multiple DomainsFunctional Medical ComplicationsPsychologicalCommunity Integration and Employment
13. Team-Based and Patient-Focused Care
14. Why are Health Services Researchers Interested in Spinal Cord Injury?High incidence and prevalence rateChanging demographicsExemplar of life-long patient-focused team-based careMultiple under-explored research fociMeasurement developmentPsychological, social, and behavioral predictors of outcomesDisparities in processes of care and patient outcomes
15. Disparities in SCIRacial and ethnic disparities in health and health-related quality of life (QOL) are well-documentedCultural factors health disparitiesPerceived discrimination and racismHealthcare system distrustHealth literacyCommunication with providerThese factors may be especially critical in SCI care
16. Race and Culture in SCI
17. Study GoalsIdentify and compare race differences in cultural and psychosocial factors in Veterans and non-Veterans with SCIInvestigate and compare race differences in wheelchair quality and quality of life (QOL): ParticipationLife satisfaction or satisfaction with servicePerceived health statusDetermine how demographic, medical, cultural and psychosocial factors are associated with racial disparities in wheelchair quality and QOL
18. MethodsDesign: Two cross-sectional multi-site studies using structured questionnairesSetting: Six National Spinal Cord Injury Model Systems centers (NSCIMS) and three VA Spinal Cord Injury centers (VA SCI)Eligibility criteria:Age > 16 yearsSCI with discernable neurological impairmentsUse a power or manual wheelchair >1 year as primary means of mobilityNon-ambulatory except for exercise purposes
19. Independent MeasuresDemographics (e.g., race, gender, age)Medical factors (e.g., SCI level)Cultural factorsExperience of discrimination Perceived racismHealthcare system distrust Health literacyCommunication with provider Psychosocial factorsAnxiety Depression
20. Cultural Factors - ExamplesExperience of discrimination - “Treated with less courtesy than other people because of your race or ethnicity.”Perceived racism - “Doctors treat people from racial or ethnic minorities the same as white people.”Healthcare system distrust - “The health care system covers up its mistakes.”Communication with provider -“Sometimes, my doctors do not listen to me.”
21. OutcomesWheelchair Quality - VA SCI participants onlyCraig Handicap Assessment and Reporting Technique Short Form (CHART-SF) - physical independence, cognitive independence, mobility, occupational functioning, social integrationSatisfaction with Life Scale - NSCIMSSatisfaction with Service - VA SCIPerceived health status: 2 items from the SF-36 - NSCIMSVeterans SF-12 - VA SCI
22. Implications for 3rd Generation Research DetectingDefine health disparitiesDefine vulnerable populationsMeasure disparities in vulnerable populationsConsider selection effects and confounding factors Understanding Identify determinants of health disparities at the following levels:Patient/individualProviderClinical encounterHealthcare system ReducingInterveneEvaluateTranslate anddisseminateChange policyFirst GenerationSecond GenerationThird Generation
23. Thank you!Contact information:Larissa Myaskovsky, PhDlarissa.myaskovsky@va.gov412-360-2241
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