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Examining healthcare disparities in a disease management population
David R Walker1, Patricia M Stern, Darryl L Landis
1CorSolutions, Inc, 9500 West Bryn Mawr Ave, Suite 500, Rosemont, IL 60018, USA. dwalker@corsolutions.com
Insights
Disease management programs may reduce racial disparities in heart failure care. A study found that initial differences in functional status between Black and White patients disappeared over time with disease management, improving overall equity.
Area of Science:
- Cardiology
- Health Services Research
- Health Equity
Background:
- Racial disparities in healthcare outcomes persist, particularly in chronic disease management.
- Heart failure (HF) management programs aim to improve patient outcomes and reduce healthcare inequities.
Purpose of the Study:
- To investigate racial disparities in a heart failure population.
- To assess the impact of disease management (DM) on these disparities.
Main Methods:
- A before-after cohort study analyzed 2619 high-risk heart failure patients (2129 White, 490 Black) in a DM program for at least 90 days.
- Functional status (New York Heart Association classification) and Quality of Life (QOL) (8-Item Short-Form Health Survey) were used to assess disparities.
- Analysis was stratified by sex and age (<65 and >=65 years).
Main Results:
- At baseline, significant disparities in functional status (NYHA class I/II) favored White patients in older men and women.
- These functional status disparities between racial groups disappeared after participation in the DM program.
- Quality of Life (QOL) disparities at baseline favored Black patients; both groups showed significant QOL improvements post-DM.
Conclusions:
- Disease management (DM) may effectively reduce and eliminate racial disparities in functional status among heart failure patients.
- DM programs show potential for promoting healthcare equity and improving outcomes in diverse patient populations.
- No significant QOL disparities were observed between Black and White patients during the study period.
Objectives:
To examine whether racial disparities in healthcare exist in a heart failure population and to estimate the impact of disease management (DM) on any identified disparities.
Study Design:
Before-after cohort study.
Patients And Methods:
A total of 2619 high-risk heart failure patients (2129 whites and 490 blacks) who participated in a DM program for at least 90 days between July 2001 and July 2003 were examined. Analysis was stratified by sex and age (< 65 years and > or = 65 years). Functional status as measured by the New York Heart Association (NYHA) classification system and mental and physical quality of life (QOL) as measured by the 8-Item Short-Form Health Survey were used to assess disparities between races.
Results:
At baseline, 33.7% of black versus 44.3% of white older women and 32.6% of black versus 48.5% of white older men were at NYHA level I or II (P < .01 and P = .005, respectively). At the most current measurement, the differences between the cohorts disappeared. Results were similar for the younger male, but not the younger female, cohort. The only QOL disparities at baseline were in favor of blacks. Both races had significant increases in mean mental and physical QOL scores (P < .001) after involvement in the DM program.
Conclusions:
Disparities in QOL were not observed between blacks and whites at baseline or over the course of the study. Disparities in functional status at baseline disappeared over time, implying that DM may help reduce disparities and maintain equity in healthcare outcomes.
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