Reducing disparities in clinical preventive services

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Racial disparities exist for a number of clinical preventive services for which scientific evidence documents improved morbidity and mortality outcomes as a result of their use (routine childhood immunizations, tetanus and flu/pneumonia immunizations, mammography, cholesterol screening, having a regular source of care, routine oral exams, sigmoidoscopy, and colonoscopy). To improve our ability to design cost- effective interventions to increase the appropriate use of clinical preventive services by members of racial and ethnic minority groups, we will: 1. Analyze the individual and contextual predictors of clinical preventive service use by racial and ethnic minorities to determine the extent to which disparities exist. 2. Compare the effects of these predictors using logistic regression across (a) different racial and ethnic groups to identify how differences result from (i) differences in population characteristics and/or (ii) differences in the effects of predictors across population AND (b) compare effects of these predictors across different clinical preventive services to identify common mutable factors. 3. Drawing on existing estimates from the literature of preventive services' health status improvements, the parameter estimates developed above, and "best estimate" costs of modifying each factor, conduct Monte Carlo simulations of the relative merits of different interventions. 4. Design and solicit additional funding for at least one intervention trial that would address a cross-cutting determinant of clinical preventive service disparities identified above. Analyses will be conducted using the MEPS, MCBS, NHIS, and California Health Interview Survey. The first two datasets provide extensive detail on independent variables with smaller sample sizes and fewer dependent variables. The latter datasets contain extensive detail on dependent variables with some loss of detail on independent variables.