December 2006

Grant Results

SUMMARY

Researchers at the City University of New York (CUNY) analyzed previous research on racial and ethnic disparities in health care delivery and created an annotated bibliography of the research, Annotated Bibliography on Racial and Ethnic Disparities in Health Care, which was in draft form when this report was written.

Key Results

  • The bibliography is organized by major disease or treatment categories, and it discusses the differential treatment of patients from racial and ethnic minorities, the impact of race and ethnicity on physician-patient communication, cultural competency training of health professionals, and issues of trust and mistrust in the health care system.

    It covers numerous studies that have documented highly significant disparities in the allocation of health care resources for African American and Hispanic patients. These disparities have ranged from the most basic components of clinical care to the use of high-tech procedures, including angioplasty, heart bypass surgery, and kidney transplantation.

Key Findings
Among the key findings in the medical literature, as reported by the project director:

  • There is widespread evidence of significant and persistent disparities in the treatment of African American and Hispanic patients.
  • Disparities are best documented in the treatment of coronary artery disease and in the use of high-tech procedures.
  • "Patient choice" accounts for only a small percentage of the disparities in treatment received, according to recent prospective studies, in which patients and physicians were interviewed.
  • Several studies have demonstrated that racial stereotypes held by physicians (for example, that minorities are unlikely to comply with rehab or have poor social supports) predicted whether an advanced procedure like angioplasty would be denied, while the clinical status of the patient did not.

Funding
The Robert Wood Johnson Foundation (RWJF) made a grant of $44,619 from February 1998 to July 2000 to support this project.

 See Grant Detail & Contact Information
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THE PROJECT

To construct a bibliography, investigators searched major databases, including MEDLINE, and identified and reviewed more than 800 publications issued from 1980 to 2001. The focus of the search was not on racial and ethnic disparities in access to the health care system, but on the differential treatment received by patients who are already in the system at some level.

These publications were narrowed to 600 relevant peer-reviewed journal articles and related literature (including monographs, commentaries, and book chapters) that are reviewed in an annotated bibliography.

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RESULTS

The Annotated Bibliography on Racial and Ethnic Disparities in Health Care is currently in draft form. The bibliography is organized by major disease or treatment categories, and it discusses the differential treatment of patients from racial and ethnic minorities, the impact of race and ethnicity on physician-patient communication, cultural competency training of health professionals, and issues of trust and mistrust in the health care system.

Key Findings

Among the key findings in the medical literature, as reported by the project director:

  • There is widespread evidence of significant and persistent disparities in the treatment of African American and Hispanic patients. There are substantially fewer studies documenting similar findings for Native Americans and those from Asian subgroups, but the same patterns are apparent.
  • Disparities are best documented in the treatment of coronary artery disease and in the use of high-tech procedures. They are also found in the most fundamental aspects of care, including: the adequacy of the physical examination, use of laboratory and radiological tests, and the management of pain, for example. In some studies following large groups of patients, these disparities have been associated with an increase in the rate of illness and death over a five-year period.
  • "Patient choice" accounts for only a small percentage of the disparities in treatment received, according to recent prospective studies, in which patients and physicians were interviewed.
  • Several studies have demonstrated that racial stereotypes held by physicians (for example, that minorities are unlikely to comply with rehab or have poor social supports) predicted whether an advanced procedure like angioplasty would be denied, while the clinical status of the patient did not.
  • There are numerous reports of minority mistrust of the health care system, but most are based on focus groups or surveys with non-random unrepresentative samples. Mistrust and knowledge of past abuses — such as the Tuskegee syphilis studies — may indeed account for low minority participation in clinical trials. It remains unclear whether this mistrust filters down to the physician and patient level when treatment choices are being made about serious illnesses.
  • There has been an explosion of interest in cultural competency training of physicians and other health workers. Many of these courses, however, focus on the ascribed behavior and beliefs of minority groups, but fail to confront the racial and ethnic biases that health care workers may hold.

The principal investigator has made a number of presentations on the findings, primarily to medical schools and professional associations (see Bibliography for details). The draft annotated bibliography has also been requested by several government and public policy groups, including the U.S. Surgeon General and the New York Academy of Medicine. A final version was expected fall 2001.

With funding from the Ford Foundation, Physicians for Human Rights has convened a panel to review the annotated bibliography and make policy recommendations aimed at eliminating health care bias. A report is expected in spring 2002. The Institute of Medicine at the National Academy of Sciences recently appointed a committee to review the evidence of racial and ethnic disparities in health care. A report is expected in January 2002.

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GRANT DETAILS & CONTACT INFORMATION

Project

Using Quality Assurance Techniques to Overcome Racial and Ethnic Differences in Health Care

Grantee

Research Foundation of the City University of New York (New York,  NY)

  • Amount: $ 44,619
    Dates: February 1998 to July 2000
    ID#:  033373

Contact

H. Jack Geiger, M.D.
(212) 650-6860
jgeiger@igc.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Sohler N, Walmsley J, Lubetkin E and Geiger HJ, "The Right to Equal Treatment: An Annotated Bibliography of Studies on Racial and Ethnic Disparities in Healthcare, Their Causes, and Related Issues." Cambridge, Mass.: Physicians for Human Rights, January 2003.

Presentations and Testimony

H. Jack Geiger, "Career Pathways in Medicine and Human Rights," Keynote Address, American Medical Student Association Regional Conference, January 13, 1999, New York University School of Medicine, New York, N.Y.

H. Jack Geiger, "Idealism, Human Rights and Medicine," at the 32nd Annual Michael Bruno Lecture, Lenox Hill Hospital, November 18, 1999, New York, N.Y.

H. Jack Geiger, "Medicine and Human Rights: The Meaning of Commitment," at the First Annual Jonathan Mann Memorial Lecture, University of New Mexico Medical School, December 8, 1999, Albuquerque, N.M.

H. Jack Geiger, "Eliminating Disparities in Health Care," at the Conference on Healthy People 2010 and Partnerships for Health in the New Millennium," Department of Health and Human Services, January 26, 2000, Washington, D.C.

H. Jack Geiger, "Medical Students as Instruments of Change: Eliminating Racial and Ethnic Bias in Medical Care," at the Public Lecture Series, Columbia University College of Physicians and Surgeons, February 15, 2000, New York, N.Y.

H. Jack Geiger, "Racial and Ethnic Bias in Medical and Nursing Care: The Recent Record," at the Fifth Annual Conference on Current Controversies in Ethics, Law and Nursing, New York University School of Nursing, April 12, 2000, New York, N.Y.

H. Jack Geiger, "The Care of Racial and Ethnic Minority Patients: Human Rights Challenges in American Medicine," at the Annual Meeting, American College of Physicians — American Society of Internal Medicine, April 15, 2000, Philadelphia, Pa.

H. Jack Geiger, "Racial and Ethnic Disparities in Diagnosis and Treatment," at the Conference on Minorities in Medical Education, Weill Cornell Medical College, May 16, 2000, New York, N.Y.

H. Jack Geiger, "Racial and Ethnic Disparities in the U.S. Health Care System: Physician Bias, Patient Choice," at the First Annual Meeting, International Society on Equity in Health, June 30, 2000, Havana, Cuba.

H. Jack Geiger, "Racial Bias: Three Decades of Evidence in the Peer-Reviewed Literature on Medical Diagnosis and Treatment," at the Summer Symposium, Kellogg Fellowship Program in Health Policy Research, National Medical Fellowships, Arden House, June 12, 2000, Harriman, N.Y.

H. Jack Geiger, "The Evidence of Racial and Ethnic Disparities in Care," Testimony before the Congressional Black Caucus, Washington, D.C., September 14, 2000. Verbal request from Rep. Danny Davis (D) Ill.

H. Jack Geiger, "Race, Diversity and Human Rights," at the Stephen Putterman Memorial Lecture, University of Massachusetts Medical School, October 2, 2000, Worcester, Mass.

H. Jack Geiger, "From Safety Net to Universal Coverage: Overcoming Barriers to Minority Health," Keynote Address, Primary Care Conference, US Department of Health and Human Services, October 11, 2000, Williamsburg, Va.

H. Jack Geiger, "Racial Disparities in Health Care: Symptoms of a Larger Sickness," at the Master Scholars Colloquium, New York University School of Medicine, November 8, 2000, New York, N.Y.

H. Jack Geiger, "Racial Bias in Health Care: Assessing the Evidence," at the Plenary Session Address, Annual Meeting, Society of Public Health Educators, November 12, 2000, Boston, Mass.

H. Jack Geiger, "Racial Disparities in Health Care: A Human Rights Challenge," at the Plenary Session Address, Annual Meeting of the American Public Health Association, November 14, 2000, Boston, Mass.

H. Jack Geiger, "The Contribution of Disparities in Diagnosis and Treatment." Plenary Session Address, Conference on Understanding and Eliminating Health Status Disparities," University of North Carolina School of Public Health, December 12, 2000, Raleigh-Durham, N.C.

H. Jack Geiger, "The Evidence of Racial/Ethnic Disparities in Treatment: What are the Causes? What Do We Need to Learn? What Should Be Done?" Testimony before the Institute of Medicine Committee on Racial and Ethnic Disparities in Medical Care, December 19, 2000, Washington, D.C. Verbal request from Dr. Brian Smedle, Staff Director for the Committee, Washington, D.C.

H. Jack Geiger, "A Bibliography on Racial/Ethnic Disparities in Medical Care," Presentation to the New York Academy of Medicine Working Group on Racial Disparities, January 8, 2001, New York, N.Y.

H. Jack Geiger, "A Review of the Evidence: Summary of the Peer-Reviewed Literature on Racial and Ethnic Disparities in Medical Care," Presentation to the Physicians for Human Rights Distinguished Panel on Racial Disparities in Care, February 7, 2001, Washington, D.C.

H. Jack Geiger, "The Contribution of Disparities in Medical Care to Racial and Ethnic Disparities in Health Status," Testimony before the Congressional Black Caucus, March 12, 1001,Washington, D.C. Verbal request from Dr. Rodney Hood, President National Medical Association, Washington D.C.

H. Jack Geiger, "Racial and Ethnic Bias in Medical Care: Ethical and Human Rights Challenges," at the Annual Alpha Omega Alpha Lecture, University of New Mexico Medical School, April 5, 2001, Albuquerque, N.M.

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Report prepared by: Gale Scott
Reviewed by: Karyn Feiden
Reviewed by: Richard Camer
Program Officer: Robert Hughes

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