The Contribution of First-name Information to the Accuracy of Racial-and-Ethnic Imputations Varies by Sex and Race-and-Ethnicity Among Medicare Beneficiaries.

Background: Data on race-and-ethnicity that are needed to measure health equity are often limited or missing. The importance of first name and sex in predicting race-and-ethnicity is not well understood.

Objective: The objective of this study was to compare the contribution of first-name information to the accuracy of basic and more complex racial-and-ethnic imputations that incorporate surname information.

Phytochelatin and coumarin enrichment in root exudates of arsenic-treated white lupin.

Soil contamination with toxic metalloids, such as arsenic, can represent a substantial human health and environmental risk. Some plants are thought to tolerate soil toxicity using root exudation, however, the nature of this response to arsenic remains largely unknown. Here, white lupin plants were exposed to arsenic in a semi-hydroponic system and their exudates were profiled using untargeted liquid chromatography-tandem mass spectrometry.

Progression of SARS-CoV-2 Seroprevalence in St. Louis, Missouri, through January 2021.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity was assessed for 3,066 individuals visiting hospitals in St. Louis, Missouri, during July 2020, November 2020, or January 2021. Seropositivity in children increased from 5.

Biorefinery potential of sustainable municipal wastewater treatment using fast-growing willow.

The use of willow plantations can be a sustainable approach for treating primary municipal wastewater, potentially reducing both the environmental and economic burdens associated with conventional treatment. However, the impact of wastewater irrigation upon the willow biorefinery potential has not yet been established. To investigate this effect, three-year-old field grown willows were harvested from plots kept as either controls or irrigated with primary municipal wastewater effluent at 29.

One In Five Fewer Heart Attacks: Impact, Savings, And Sustainability In San Diego County Collaborative.

Before 2011 rates of hospitalization for heart attacks were about the same in San Diego County as they were in the rest of California. In 2011 a multistakeholder population health collaborative consisting of partners at the federal, state, and local levels launched Be There San Diego. The collaborative's goal was to reduce cardiovascular events through the spread of best practices aimed at improving control of hypertension, lipid levels, and blood sugar and through patient and medical community activation.

How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans?

Background: Healthcare Effectiveness Data and Information Set (HEDIS) quality measures have long been used to compare care across health plans and to study racial/ethnic and socioeconomic disparities among Medicare Advantage (MA) beneficiaries. However, possible gender differences in seniors' quality of care have received less attention.

Objective: To test for the presence and nature of any gender differences in quality of care across MA Plans, overall and by domain; to identify those most at risk of poor care.

Mapping the Gaps: Gender Differences in Preventive Cardiovascular Care among Managed Care Members in Four Metropolitan Areas.

Background: Prior research documents gender gaps in cardiovascular risk management, with women receiving poorer quality routine care on average, even in managed care systems. Although population health management tools and quality improvement efforts have led to better overall care quality and narrowing of racial/ethnic gaps for a variety of measures, we sought to quantify persistent gender gaps in cardiovascular risk management and to assess the performance of routinely used commercial population health management tools in helping systems narrow gender gaps.

Methods: Using 2013 through 2014 claims and enrollment data from more than 1 million members of a large national health insurance plan, we assessed performance on seven evidence-based quality measures for the management of coronary artery disease and diabetes mellitus, a cardiac risk factor, across and within four metropolitan areas.

Improving Population Health Through an Innovative Collaborative: The Be There San Diego Data for Quality Group.

In 2012, leaders from disparate health care organizations established a data group aligned around a regional goal of preventing heart attacks and strokes in San Diego. The group---now named the Be There San Diego Data for Quality (DFQ) Group---is a safe venue for medical directors and other quality-improvement leaders to share performance data on quality-of-care measures for diabetes, hypertension, and cardiovascular disease, as well as insights, lessons learned, and challenges faced by each organization in treating these conditions. The DFQ Group has focused its efforts on improving the quality of services provided by each participating health care organization, and has placed a strong emphasis on analyzing trends in combined quality data to better understand the health of the entire San Diego population.

When Race/Ethnicity Data Are Lacking: Using Advanced Indirect Estimation Methods to Measure Disparities.

A key aim of U.S. health care reforms is to ensure equitable care while improving quality for all Americans.

Imputing Missing Race/Ethnicity in Pediatric Electronic Health Records: Reducing Bias with Use of U.S. Census Location and Surname Data.

Objective: To assess the utility of imputing race/ethnicity using U.S. Census race/ethnicity, residential address, and surname information compared to standard missing data methods in a pediatric cohort.

Mapping Gender Differences in Cardiovascular Disease and Diabetes Care: A Pilot Assessment of LDL Cholesterol Testing Rates in a California Health Plan.

Despite improvements over recent decades in care for cardiovascular disease (CVD) and diabetes, which is a major CVD risk factor, evidence suggests that the care women receive-and their health outcomes-continue to lag behind those of men, even for routine care, such as monitoring and control of cholesterol. Awareness of and action to address gender gaps in women's CVD care are limited, in part, because quality of care is not routinely measured and reported by gender. This pilot project describes and maps gender differences in CVD and diabetes care using data from a large health plan.

Bridging the gap between basic science and clinical practice: a role for community clinicians.

Background: Translating the extraordinary scientific and technological advances occurring in medical research laboratories into care for patients in communities throughout the country has been a major challenge. One contributing factor has been the relative absence of community practitioners from the US biomedical research enterprise. Identifying and addressing the barriers that prevent their participation in research should help bridge the gap between basic research and practice to improve quality of care for all Americans.

A Prototype Interactive Mapping Tool to Target Low Health Literacy in Missouri.

An estimated 36 percent of American adults have health literacy levels rated at "basic or below," indicating that they have difficulty obtaining, processing, and understanding basic health information and services. To help healthcare decisionmakers in Missouri identify neighborhood-level "hotspots" of suboptimal health or healthcare that may be due to low health literacy, RAND developed a prototype interactive web-based mapping tool. This builds on earlier RAND work to develop a predictive model of health literacy and estimate levels of health literacy in small geographic areas (e.

Developing predictive models of health literacy.

Introduction: Low health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is largely unaddressed in public health and clinical practice. To help overcome these limitations, we developed two models to estimate health literacy.

Training a patient safety work force: the patient safety improvement corps.

Objective: Evaluate short-term effects of the Patient Safety Improvement Corps (PSIC), an Agency for Healthcare Research and Quality–sponsored program to train state teams in patient safety skills/tools, to assess its contribution to building a national infrastructure supporting effective patient safety practices.

Data Source: Self-reported information gathered from (1) group interviews at the end of each year; (2) individual telephone interviews 1 year later; (3) faxed information forms 2 years later.

Study Design: Program evaluation of immediate and short-term process and impact (use of skills/tools, information sharing, changes in practice).

The National Health Plan Collaborative to Reduce Disparities and Improve Quality.

Background: Despite numerous reports and initiatives, progress in reducing racial/ethnic disparities in health care has been slow. The National Health Plan Collaborative (NHPC), a novel public-private partnership between nine health plans covering approximately 95 million lives, leading learning and research organizations, the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation, was established in December 2004 to address these disparities.

Progress To Date: The health plans were able to overcame initial challenges in obtaining information on race/ethnicity of their enrollees and examined their diabetes performance measure to assess disparities in care.

A new method for estimating race/ethnicity and associated disparities where administrative records lack self-reported race/ethnicity.

Objective: To efficiently estimate race/ethnicity using administrative records to facilitate health care organizations' efforts to address disparities when self-reported race/ethnicity data are unavailable.

Data Source: Surname, geocoded residential address, and self-reported race/ethnicity from 1,973,362 enrollees of a national health plan.

Study Design: We compare the accuracy of a Bayesian approach to combining surname and geocoded information to estimate race/ethnicity to two other indirect methods: a non-Bayesian method that combines surname and geocoded information and geocoded information alone.

Challenges to using a business case for addressing health disparities.

The authors consider the challenges to quantifying both the business case and the social case for addressing disparities, which is central to achieving equity in the U.S. health care system.

Differential diffusion of HIV technologies by gender: the case of highly active antiretroviral therapy.

We sought to examine whether diffusion of new HIV technologies differed by gender in the United States, the source of any such disparities, and whether disparities narrow over time as technologies become more established. In particular, we assess how rates of use of highly active antiretroviral therapy (HAART) varied between males and females during the late 1990s, when HAART was rapidly diffusing. We examined data from a prospective cohort study of a national probability sample of 1421 HIV-infected adults in medical care who were enrolled in the HIV Cost and Services Utilization Study (HCSUS) from January 1996 to December 1998.

Differences in HIV care between patients with and without severe mental illness.

Objective: This study explored how HIV care differs for infected persons with and without severe mental illness.

Methods: Data were obtained through interviews with and chart review of 295 patients with severe mental illness and HIV from public mental health agencies in Los Angeles County and New York City. Data were compared with data from 1,294 HIV patients without severe mental illness from a separate national probability sample.

Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans?

Purpose: To assess gender differences in the quality of care for cardiovascular disease and diabetes for enrollees in managed care plans.

Methods: We obtained data from 10 commercial and 9 Medicare plans and calculated performance on 6 Health Employer Data and Information Set (HEDIS) measures of quality of care (beta-blocker use after myocardial infarction [MI], low-density lipoprotein cholesterol [LDL-C] check after a cardiac event, and in diabetics, whether glycosylated hemoglobin [HgbA1c], LDL cholesterol, nephropathy, and eyes were checked) and a 7th HEDIS-like measure (angiotensin-converting enzyme [ACE] inhibitor use for congestive heart failure). A smaller number of plans provided HEDIS scores on 4 additional measures that require medical chart abstraction (control of LDL-C after cardiac event, blood pressure control in hypertensive patients, and HgbA1c and LDL-C control in diabetics).