Racial and Ethnic Disparities in Diabetes Care and Impact of Vendor-Based Disease Management Programs.

Objective: We examined the existence of disparities in receipt of appropriate diabetes care among California's fee-for-service Medicaid beneficiaries and the effectiveness of a telephonic-based disease management program delivered by a disease management vendor on the reduction of racial/ethnic disparities in diabetes care.

Research Design And Methods: We conducted an intervention-control cohort study to test the effectiveness of a 3-year-long disease management program delivered to Medicaid fee-for-service beneficiaries aged 22 to 75 with a diagnosis of diabetes in Los Angeles and Alameda counties. The outcome measures were the receipt of at least one hemoglobin A1c (HbA1c) test, LDL cholesterol test, and retinal examination each year.

Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions: Measuring Care Outcomes.

Background: Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare.

Objectives: We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles.

Associations between self-perception of weight, food choice intentions, and consumer response to calorie information: a retrospective investigation of public health center clients in Los Angeles County before the implementation of menu-labeling regulation.

Background: Although obesity continues to rise and remains a great public health concern in the U.S., a number of important levers such as self-perception of weight and calorie postings at point-of-purchase in restaurants are still not well-characterized in the literature, especially for low-income and minority groups in Los Angeles County (LAC).

Focus on Quality: Investigating Residents' Learning Climate Perceptions.

Background: A department's learning climate is known to contribute to the quality of postgraduate medical education and, as such, to the quality of patient care provided by residents. However, it is unclear how the learning climate is perceived over time.

Objectives: This study investigated whether the learning climate perceptions of residents changed over time.

Lunchtime School Water Availability and Water Consumption Among California Adolescents.

Purpose: To examine the potential impact of California SB 1413, which required school districts to provide free, fresh drinking water during mealtimes in food service areas by July 1, 2011, on greater water consumption among California adolescents.

Methods: Data were drawn from the 2012 and 2013 state-representative California Health Interview Survey. A total of 2,665 adolescents aged 12-17 years were interviewed regarding their water consumption and availability of free water during lunchtime at their school.

G-computation demonstration in causal mediation analysis.

Recent work has considerably advanced the definition, identification and estimation of controlled direct, and natural direct and indirect effects in causal mediation analysis. Despite the various estimation methods and statistical routines being developed, a unified approach for effect estimation under different effect decomposition scenarios is still needed for epidemiologic research. G-computation offers such unification and has been used for total effect and joint controlled direct effect estimation settings, involving different types of exposure and outcome variables.

Patient volumes and pre- and postdischarge postpartum infection: A retrospective cohort study.

Background: To examine the association between hospital and clinician obstetric volume and postpartum infection risk in the pre- and postdischarge periods.

Methods: We used data from the 2011 New York State Inpatient and Emergency Department Databases to fit generalized estimating equation models to examine the effect of hospital and clinician obstetric volume on infection before discharge and in the 30 days after discharge after delivery.

Results: Higher clinician volume was associated with lower predischarge infection risk (odds ratio [OR] for first vs third quartile was 0.

Beyond limitations: Improving how we handle uncertainty in health professions education research.

The researchers' assumptions invariably influence research outcomes. This is true for both qualitative and quantitative studies. Assumptions or choices regarding underlying theories, causal relations, study setting and population, sampling strategies, participant non-response, data collection, data analysis, and researchers' perceptions and interpretations of results are among factors that can induce uncertainty in research findings.

Role models and social supports related to adolescent physical activity and overweight/obesity.

Positive role models, social and community activities, and school support are protective social factors that promote youth health and well-being. Latino, African-American, Asian, multi-racial, and low-income adolescents are less likely to experience these protective social factors compared to other groups, which may contribute to health disparities. Adolescents who identify a role model, volunteer, participate in organizations outside of school, or experience high levels of teacher or other adult support at school engage in greater physical activity and are more likely to have a healthy weight.

Embracing the Complexity of Valid Assessments of Clinicians' Performance: A Call for In-Depth Examination of Methodological and Statistical Contexts That Affect the Measurement of Change.

Assessments of clinicians' professional performance have become more entrenched in clinical practice globally. Systems and tools have been developed and implemented, and factors that impact performance in response to assessments have been studied. The validity and reliability of data yielded by assessment tools have been studied extensively.

Revisiting the D-RECT tool: Validation of an instrument measuring residents' learning climate perceptions.

Introduction: Credible evaluation of the learning climate requires valid and reliable instruments in order to inform quality improvement activities. Since its initial validation the Dutch Residency Educational Climate Test (D-RECT) has been increasingly used to evaluate the learning climate, yet it has not been tested in its final form and on the actual level of use - the department.

Aim: Our aim was to re-investigate the internal validity and reliability of the D-RECT at the resident and department levels.

Sources of Interactional Problems in a Survey of Racial/Ethnic Discrimination.

Cross-cultural variability in respondent processing of survey questions may bias results from multiethnic samples. We analyzed behavior codes, which identify difficulties in the interactions of respondents and interviewers, from a discrimination module contained within a field test of the 2007 California Health Interview Survey. In all, 553 (English) telephone interviews yielded 13,999 interactions involving 22 items.

In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use And Fewer Hospitalizations.

The expansion of health insurance to millions of Americans through the Affordable Care Act has given rise to concerns about increased use of emergency department (ED) and hospital services by previously uninsured populations. Prior research has demonstrated that continuity with a regular source of primary care is associated with lower use of these services and with greater patient satisfaction. We assessed the impact of a policy to increase patients' adherence to an individual primary care provider or clinic on subsequent use of ED and hospital services in a California coverage program for previously uninsured adults called the Health Care Coverage Initiative.

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

Background: The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders.

Objective: To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS).

Design: Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics.

Linking Health System Responsiveness to Political Rights and Civil Liberties: A Multilevel Analysis Using Data From 44 Countries.

Responsiveness is a dimension of health system functioning and might be dependent upon contextual factors related to politics. Given this, we performed cross-national comparisons with the aim of investigating: 1) the associations of political factors with patients' reports of health system responsiveness and 2) the extent to which health input and output might explain these associations. World Health Survey data were analyzed for 44 countries (n = 103 541).

One-stop shopping: efforts to integrate physical and behavioral health care in five California community health centers.

More than 70 percent of behavioral health conditions are first diagnosed in the primary care setting. Yet physical and behavioral health care are typically provided separately, compelling many vulnerable patients to navigate the complexities of two separate systems of care. This policy brief examines five community health centers (CHCs) in California that have taken preliminary steps toward creating "one-stop shopping" for both physical and behavioral health care.

Impact of family history assessment on communication with family members and health care providers: A report from the Family Healthware™ Impact Trial (FHITr).

Objective: This study examines the impact of Family Healthware™ on communication behaviors; specifically, communication with family members and health care providers about family health history.

Methods: A total of 3786 participants were enrolled in the Family Healthware™ Impact Trial (FHITr) in the United States from 2005-7. The trial employed a two-arm cluster-randomized design, with primary care practices serving as the unit of randomization.

Neighborhood, family and individual characteristics related to adolescent park-based physical activity.

Background: Local parks are an important community resource that may influence levels of physical activity among youth. However, few population-based studies have investigated park-based physical activity among youth.

Purpose: This study examines sociodemographic, family, and neighborhood characteristics associated with park-based physical activity among adolescents.

Early diffusion of gene expression profiling in breast cancer patients associated with areas of high income inequality.

With the Affordable Care Act reducing coverage disparities, social factors could prominently determine where and for whom innovations first diffuse in health care markets. Gene expression profiling is a potentially cost-effective innovation that guides chemotherapy decisions in early-stage breast cancer, but adoption has been uneven across the United States. Using a sample of commercially insured women, we evaluated whether income inequality in metropolitan areas was associated with receipt of gene expression profiling during its initial diffusion in 2006-07.

Trends in sexual orientation missing data over a decade of the California Health Interview Survey.

Objectives: We explored changes in sexual orientation question item completion in a large statewide health survey.

Methods: We used 2003 to 2011 California Health Interview Survey data to investigate sexual orientation item nonresponse and sexual minority self-identification trends in a cross-sectional sample representing the noninstitutionalized California household population aged 18 to 70 years (n = 182 812 adults).

Results: Asians, Hispanics, limited-English-proficient respondents, and those interviewed in non-English languages showed the greatest declines in sexual orientation item nonresponse.

Reach of Supplemental Nutrition Assistance Program-Education (SNAP-Ed) interventions and nutrition and physical activity-related outcomes, California, 2011-2012.

Introduction: This study combined information on the interventions of the US Department of Agriculture's Supplemental Nutrition Assistance Program-Education with 5,927 interview responses from the California Health Interview Survey to investigate associations between levels of intervention reach in low-income census tracts in California and self-reported physical activity and consumption of fruits and vegetables, fast food, and sugar-sweetened beverages.

Methods: We determined 4 levels of intervention reach (low reach, moderate reach, high reach, and no intervention) across 1,273 program-eligible census tracts from data on actual and eligible number of intervention participants. The locations of California Health Interview Survey respondents were geocoded and linked with program data.

Racial and Ethnic Disparities in Colonoscopic Examination of Individuals With a Family History of Colorectal Cancer.

Background & Aims: Guidelines recommend that persons with a high-risk family history of colorectal cancer (CRC) undergo colonoscopy examinations every 5 years, starting when they are 40 years old. We investigated factors associated with colonoscopy screening of individuals with a family history of CRC, focusing on race and ethnicity.

Methods: In a retrospective study, we analyzed data from the 2009 California Health Interview Survey on persons 40-80 years old with a first-degree relative (mother, father, sibling, or child) with CRC who had visited a physician within the past 5 years.

A Systematic Review of the Impact of Physicians' Occupational Well-Being on the Quality of Patient Care.

Background: It is widely held that the occupational well-being of physicians may affect the quality of their patient care. Yet, there is still no comprehensive synthesis of the evidence on this connection.

Purpose: This systematic review studied the effect of physicians' occupational well-being on the quality of patient care.