UCLA/DREW/RAND PROGRAM TO ADDRESS DISPARITIES IN HEALTH

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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.