Understanding How Components of Black Racial Identity and Racial Realities May Impact Healthcare Utilization: A Randomized Study

Purpose: Studies have suggested that even when minority groups have potential access to healthcare, they may have inadequate utilization (realized access). This study explores the application of a theory from the social psychology and political science literatures concerning how racial centrality and racial realities, specifically amongst Blacks, may influence patients’ healthcare utilization preferences. Methods: We created a survey with two (pseudo) randomized, controlled experimental treatments designed to assess whether racialized hospital and physician characteristics elicited a preference from Black or White respondents, as well as questions aimed at understanding participants’ different beliefs and levels of knowledge about past and current racial health disparities. The survey was distributed online by Qualtrics to paid Black (n=225) and White (n=75) participants. Data were analyzed using bivariable statistics. Results: Black respondents preferred a hospital with an advertisement featuring Black healthcare workers (p\u3c.01), an association that was correlated with higher levels of Black centrality (p\u3c.01), beliefs that the Tuskegee Syphilis Experiment could happen today (p\u3c.05), and a lack of trust in the healthcare system (p\u3c.01). No such association was observed for White respondents. Neither White nor Black respondents showed any significant associations concerning preference for a physician with a racialized name. Blacks respondents were significantly more likely to answer questions concerning the existence of health disparities correctly; however, there was no difference in the number of healthcare-related discriminatory experiences or general trust of healthcare organizations observed between respondents of the two races. Conclusions: Black subjects appeared to prefer health institutions that give the outward appearance of being diverse. This choice was associated with racial group centrality and knowledge of certain racial realities. As more equal access is legislated, the role racial identity plays in affecting utilization patterns should be better understood in order to inform future health care programs and policies

Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis

Summarizes a study of whether screening for problem drinking and interventions to reduce alcohol intake in hospital trauma centers reduce the direct cost of injury-related health care. Compares the costs of injury recidivism with and without intervention

Prediction of chronic disability in work-related musculoskeletal disorders: a prospective, population-based study

BACKGROUND: Disability associated with work-related musculoskeletal disorders is an increasingly serious societal problem. Although most injured workers return quickly to work, a substantial number do not. The costs of chronic disability to the injured worker, his or her family, employers, and society are enormous. A means of accurate early identification of injured workers at risk for chronic disability could enable these individuals to be targeted for early intervention to promote return to work and normal functioning. The purpose of this study is to develop statistical models that accurately predict chronic work disability from data obtained from administrative databases and worker interviews soon after a work injury. Based on these models, we will develop a brief instrument that could be administered in medical or workers' compensation settings to screen injured workers for chronic disability risk. METHODS: This is a population-based, prospective study. The study population consists of workers who file claims for work-related back injuries or carpal tunnel syndrome (CTS) in Washington State. The Washington State Department of Labor and Industries claims database is reviewed weekly to identify workers with new claims for work-related back injuries and CTS, and these workers are telephoned and invited to participate. Workers who enroll complete a computer-assisted telephone interview at baseline and one year later. The baseline interview assesses sociodemographic, employment-related, biomedical/health care, legal, and psychosocial risk factors. The follow-up interview assesses pain, disability, and work status. The primary outcome is duration of work disability over the year after claim submission, as assessed by administrative data. Secondary outcomes include work disability status at one year, as assessed by both self-report and work disability compensation status (administrative records). A sample size of 1,800 workers with back injuries and 1,200 with CTS will provide adequate statistical power (0.96 for low back and 0.85 for CTS) to predict disability with an alpha of .05 (two-sided) and a hazard ratio of 1.2. Proportional hazards regression models will be constructed to determine the best combination of predictors of work disability duration at one year. Regression models will also be developed for the secondary outcomes