UCLA/DREW/RAND PROGRAM TO ADDRESS DISPARITIES IN HEALTH

为了解决健康方面的差异，有必要了解影响医疗保健使用和行为的因素，以及在接受医疗保健的背景下发生的健康行为。加州大学洛杉矶分校/DREW/兰德解决健康差异的计划测试了一个综合模型（基于安德森、多纳布尔迪恩和瓦格纳模型），以确定导致差异的最显着因素，并测试解决这些问题的随机干预措施。 待检验的假设集中在该模型的各个方面。该方案的重点是迫切需要改善城市地区黑人和拉丁美洲人的健康状况。该计划包括6个项目。项目1使用国家数据评估黑人/白色婴儿死亡率差异在多大程度上反映了新生儿重症监护质量的差异。项目2使用4个大型数据集，以确定与种族和民族的临床预防服务的差异使用相关的因素，以及某些因素对种族/民族群体的差异影响程度。项目3使用基于人群的样本研究了在黑人中，错过诊断和诊断的差异治疗机会导致诊断后期和结肠癌死亡率较高的程度。项目4开发了文化上适当的工具，用于衡量安全网人口的护理质量和满意度，并使用这些工具对这一人口进行检查。项目5评估干预措施的有效性，以改善拉丁美洲糖尿病患者的自我护理。项目6研究干预措施的有效性，通过加强病例管理和坚持培训来改善黑人和拉丁美洲艾滋病毒感染者的结果。这四个非干预性项目将被用作随后开展其他干预性研究的基础。四个核心（行政，社会科学，数据和统计分析，翻译-传播-文化适应）将支持研究工作。该方案的一个主要目标是提高对少数民族机构之间的差异进行保健服务研究的能力，该机构是该方案项目的主要合作伙伴之一。随后的资源已分配给发展利益相关者-调查员伙伴关系，以确保最大限度地为研究提供社区投入，并有效地传播和将研究结果转化为实践。

To address disparities in health it is necessary to understand the factors that influence health care use and behavior, as well as health behaviors that occur in the context of receiving medical care. The UCLA/DREW/RAND Program to Address Disparities in Health tests an integrated model (based on the Anderson, Donabledean and Wagner models) to identify the most salient factors responsible for disparities and tests randomized interventions that address them. Hypothesis to be tested focus upon aspects of this model. The Program focuses on the urgent need to improve the health outcomes of Blacks and Latinos in urban areas. The program includes 6 projects. Project 1 uses national data to assess the extent to which black/white infant mortality differences reflect differences in quality of neonatal intensive care. Project 2 uses 4 large data sets to determine the factors related to differential use of clinical preventive services by race and ethnicity and the extent to which certain factors differentially affect racial/ethnic groups. Project 3 studies the extent to which missed opportunities for diagnosis and differential treatment of the diagnosis are responsible for later stage at diagnosis and higher mortality from colon cancer among blacks, using a population based sample. Project 4 develops culturally appropriate tools for measuring quality of and satisfaction with care in a safety net population, and uses these tools to examines in this population. Project 5 evaluates the effectiveness of intervention to improve outcomes among Latino diabetics by improving their self-care. Project 6 studies the effectiveness of intervention to improve outcomes of blacks and Latinos with HIV disease through enhanced case management and adherence training. The four non-intervention projects will be used as the basis for subsequent development of additional intervention studies. Four cores (Administrative, Social Science, Data and Statistical Analysis, and Translation-Dissemination-Cultural Adaptation) will support the research effort. A major objective of the Program is to increase capacity for health services research on disparities among minority institution, which is one of the key partners in the Program Project. Subsequent resources have been allocated to developing Stakeholder-Investigator Partnerships to ensure maximal community input into the research as well as effective dissemination and translation of the findings into practice.