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Alan M. Zaslavsky - One of the best experts on this subject based on the ideXlab platform.
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testing for statistical discrimination by race ethnicity in panel data for depression treatment in primary care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.
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Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.
Thomas G. Mcguire - One of the best experts on this subject based on the ideXlab platform.
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testing for statistical discrimination by race ethnicity in panel data for depression treatment in primary care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.
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Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.
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Clinical Uncertainty and Healthcare Disparities
American journal of law & medicine, 2003Co-Authors: Ana I. Balsa, Seiler N, Thomas G. McguireAbstract:I. INTRODUCTION The Institute of Medicine Report, Unequal Treatment: Confronting Racial and Ethnic Disparities, affirms in its first finding: "Racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable."1 The mechanisms that generate racial and ethnic disparities in medical care operate at the levels of the healthcare system and the Clinical encounter. Research demonstrates the role of healthcare system factors, including differences in insurance coverage and other determinants of healthcare access, in producing disparities. Research also shows, however, that even when insurance status and other measures of access are controlled for by statistical methods, racial and ethnic disparities persist. These disparities remain when researchers try by various methods to control for patients' Clinical characteristics. Disparities are especially well documented through comparisons between white patients and African Americans and Latinos, but they are believed to affect other minority groups. As a result, many members of minority racial and ethnic groups receive less or inferior care.2 The purpose of this Article is to explore how one factor we regard to be key-provider and patient Uncertainty about Clinical decisions-contributes to disparities arising from the doctor-patient encounter. Uncertainty is a powerful force in medicine. Wennberg argues that Uncertainty is the most important single influence on physician behavior.3 He divides Clinical Uncertainty into several categories-Uncertainty about the nature of the patient's disease condition or health status, Uncertainty about the effectiveness of a treatment even under ideal conditions and Uncertainty about patient preferences and values. Arrow's cornerstone paper in health economics seeks to understand the medical care sector's special institutional characteristics and behavioral norms as social adaptations to Clinical Uncertainty.4 Uncertainty also pervades the legal and regulatory governance of the health sphere, undermining efforts to pursue fairness and efficiency through public policy.5 In what follows, we stress several roles for Uncertainty as a contributor to healthcare disparities. First, Uncertainty opens the way for myriad subjective influences on physicians' diagnostic and therapeutic assessments. The Uncertainty of which we speak has a number of sources. These include ambiguity as to the diagnostic implications of Clinical symptoms, signs and laboratory tests; incomplete information about the efficacy of diagnostic and therapeutic interventions; and unresolved differences of opinion about how to value potential Clinical outcomes. These sources of Uncertainty create wide space for Clinical discretion. Subjective influences, including unfavorable stereotypes and attitudes about social groups, shape the exercise of this discretion.6 A second role for Uncertainty has a very different character. Well-meaning clinicians, trying to act in their patients' best interests, look to gather as much information as they can, within time and resource constraints, concerning their patients' needs and interests, both biological and psychological. To do so, physicians must communicate with their patients-and listen closely to what patients have to say. If physicians, as a group, communicate less well with their minority patients than with Whites, greater Uncertainty about minority patients' needs and interests results. This "Uncertainty gap," we contend, can produce disparate treatment of patients from different racial and ethnic groups even in the absence of physician-held stereotypes or prejudice. Evidence suggests that such an Uncertainty gap exists-that there is more "noise" in the communication "signal" when doctor and patient belong to different racial or ethnic groups with correspondingly different cultural patterns and styles. Third, patients who are, if anything, even more uncertain about the value of medical interventions than are their doctors,7 make their own interactive assessments of the quality and reliability of their doctors' judgments. …
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Prejudice, Clinical Uncertainty and stereotyping as sources of health disparities.
Journal of health economics, 2003Co-Authors: Ana I. Balsa, Thomas G. McguireAbstract:Disparities in health can result from the Clinical encounter between a doctor and a patient. This paper studies three possible mechanisms: prejudice of doctors in the form of being less willing to interact with members of minority groups, Clinical Uncertainty associated with doctors' differential interpretation of symptoms from minority patients or from doctor's distinct priors across races, and stereotypes doctors hold about health-related behavior of minority patients. Within a unified conceptual framework, we show how all three can lead to disparities in health and health services use. We also show that the effect of social policy depends critically on the underlying cause of disparities.
Guy Goodwin - One of the best experts on this subject based on the ideXlab platform.
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Bipolar disorder: Clinical Uncertainty, evidence-based medicine and large-scale randomised trials
British Journal of Psychiatry, 2001Co-Authors: John Geddes, Guy GoodwinAbstract:BackgroundThe increasing use of the methods of evidence-based medicine to keep up-to-date with the research literature highlights the absence of high-quality evidence in many areas in psychiatry.AimsTo outline current uncertainties in the maintenance treatment of bipolar disorder and to describe some of the decisions involved in designing a large simple trial.MethodWe describe some of the strategies of evidence-based medicine, and how they can be applied in practice, focusing specifically on the area of bipolar disorder.ResultsOne of the key Clinical uncertainties in the treatment of bipolar disorder is the place of maintenance drug treatments and their relative efficacy. A large-scale study, the Bipolar Affective Disorder: Lithium Anticonvulsant Evaluation (BALANCE) trial, is proposed to compare the effectiveness of lithium, valproate and the combination of lithium and valproate.ConclusionsProviding reliable answers to key Clinical questions in psychiatry will require new approaches to Clinical trials. These will need to be far larger than previously appreciated and will therefore need to be collaborative ventures involving front-line clinicians.
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Bipolar disorder: Clinical Uncertainty, evidence-based medicine and large-scale randomised trials.
The British journal of psychiatry. Supplement, 2001Co-Authors: John Geddes, Guy GoodwinAbstract:The increasing use of the methods of evidence-based medicine to keep up-to-date with the research literature highlights the absence of high-quality evidence in many areas in psychiatry. To outline current uncertainties in the maintenance treatment of bipolar disorder and to describe some of the decisions involved in designing a large simple trial. We describe some of the strategies of evidence-based medicine, and how they can be applied in practice, focusing specifically on the area of bipolar disorder. One of the key Clinical uncertainties in the treatment of bipolar disorder is the place of maintenance drug treatments and their relative efficacy. A large-scale study, the Bipolar Affective Disorder: Lithium Anticonvulsant Evaluation (BALANCE) trial, is proposed to compare the effectiveness of lithium, valproate and the combination of lithium and valproate. Providing reliable answers to key Clinical questions in psychiatry will require new approaches to Clinical trials. These will need to be far larger than previously appreciated and will therefore need to be collaborative ventures involving front-line clinicians.
Timothy P Hofer - One of the best experts on this subject based on the ideXlab platform.
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the role of Clinical Uncertainty in treatment decisions for diabetic patients with uncontrolled blood pressure
Annals of Internal Medicine, 2008Co-Authors: Eve A Kerr, Brian J Zikmundfisher, Mandi L Klamerus, Usha Subramanian, Mary M Hogan, Timothy P HoferAbstract:Clinicians often fail to intensify antihypertensive therapy when their patient's blood pressure is elevated. Kerr and colleagues sought the reasons for this practice by studying 1169 diabetic patie...
John Z. Ayanian - One of the best experts on this subject based on the ideXlab platform.
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testing for statistical discrimination by race ethnicity in panel data for depression treatment in primary care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.
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Testing for Statistical Discrimination by Race/Ethnicity in Panel Data for Depression Treatment in Primary Care
Health Services Research, 2008Co-Authors: Thomas G. Mcguire, John Z. Ayanian, Daniel E. Ford, Rachel Mosher Henke, Kathryn Rost, Alan M. ZaslavskyAbstract:In the Institute of Medicine (IOM) (2003)Unequal Treatment report, “discrimination” refers to a health care provider's treatment of patients with similar health care needs differently due to the patient's race or ethnicity. Investigators have studied three types of discrimination—affective bias, cognitive stereotyping, and statistical discrimination (Hilton and von Hippel 1996; Fiske 1998; Dovidio 1999; Balsa and McGuire 2003; IOM 2003; Escarce 2005; Fennell 2005), noting that each type of discrimination has distinct implications for appropriate remedial actions (Balsa and McGuire 2003). Statistical discrimination appears to be a potent (if more difficult to observe) source of discrimination in health care use (Balsa, McGuire, and Meredith 2005; Lutfey and Ketcham 2005; Werner 2005). In statistical discrimination, providers apply correct information about a group to reduce their Clinical Uncertainty about an individual patient. While discrimination stemming from affective bias and cognitive stereotyping is generally expected to reduce treatment of minorities in comparison with whites, statistical discrimination may or may not exacerbate race/ethnicity gaps in treatment (Balsa and McGuire 2001). Statistical discrimination can be in the minority patient's best interest if physicians use reliable group differences in the absence of reliable data about the individual. Nonetheless, if physician must rely less on individual level information, treatment for minority patients is less likely to be matched well to their individual needs. When poor communication exacerbates Clinical Uncertainty, providers give undue weight to group-based generalizations, taking the form of diminished responsiveness to the circumstances of an individual patient. Prior research has documented worse communication between white providers and minority patients compared with white patients (see, for example, Cooper-Patrick et al. 1999). Because providers primarily rely on patient report to judge the severity of depression, effective communication is particularly important for the physician to allocate severity-appropriate treatment resources for this condition. The objective of this paper is to test the hypothesis that providers employ statistical discrimination in treating depressed patients over time. Specifically, we assess whether treatment intensity changes as depression severity changes comparably over 2 years for minority and white patients.