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。UCLA/DREW/RAND解决健康差异项目测试了一个综合模型（基于Anderson、Donabledean和Wagner模型），以确定造成差异的最显著因素，并测试了解决这些差异的随机干预措施。有待检验的假设集中在这个模型的各个方面。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使用国家数据来评估黑人/白人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个大型数据集来确定与不同种族和民族使用临床预防服务的差异有关的因素，以及某些因素对种族/民族群体的差异影响程度。项目3使用基于人口的样本，研究错过诊断和鉴别治疗机会在多大程度上导致黑人结肠癌诊断阶段较晚和死亡率较高。项目4开发了文化上适合的工具，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些人口进行检查。项目5评估干预的有效性，以改善拉丁裔糖尿病患者的结果，改善他们的自我保健。项目6研究通过加强病例管理和依从性培训，改善感染艾滋病毒的黑人和拉丁裔患者预后的干预措施的有效性。这四个非干预项目将作为后续开展更多干预研究的基础。四个核心（行政管理、社会科学、数据与统计分析、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保健服务研究少数民族机构之间差异的能力，这是该方案项目的主要合作伙伴之一。随后的资源已分配用于发展利益攸关方-研究者伙伴关系，以确保最大限度地利用社区对研究的投入，以及有效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.