April is Minority Health Month, a time to call attention to the inequities experienced by racial and ethnic minorities. These groups tend to receive lower-quality care and experience poorer health outcomes than whites. Such healthcare disparities include:
- The rates of death before age 75 from stroke and coronary heart disease were higher among non-Hispanic blacks than among whites, according to a 2013 assessment by the US Centers for Disease Control and Prevention.
- Among emergency department visits for immediate conditions, the percentage of patients who had to wait an hour or more was higher for blacks than for whites, as measured in 2009–2010 and reported by the Agency for Healthcare Research and Quality (AHRQ).
- The percentage of people with a specific source of ongoing care (e.g., a primary care physician), which contributes to better overall care, was significantly lower for Hispanics than for non-Hispanic whites in 2010, according to the AHRQ report.
To address such inequities, PCORI established Addressing Disparities as one of the five areas in our National Priorities for Research and Research Agenda. The Addressing Disparities program aims to reduce disparities in healthcare outcomes and advance equity in health and healthcare.
Awards Supporting Minority Health Goals
To date, PCORI has funded more than 100 research projects that focus on racial and ethnic minority populations. Thirty-five of those projects are in the Addressing Disparities portfolio.
The Addressing Disparities program funds comparative effectiveness research (CER) that goes beyond describing disparities to identify the best options for reducing or eliminating these pervasive gaps in healthcare processes and outcomes. In addition, we seek to disseminate and increase uptake of promising practices that evolve from the CER we fund. More than $68 million of the $75 million awarded by the Addressing Disparities program so far is supporting research to identify interventions for reducing racial and ethnic disparities; some of these projects also overlap with other priority populations, such as rural and low-income groups. The populations represented in these studies include African Americans (21 studies), Hispanic/Latinos (9), American Indians (4), and Asian Americans (1).
The projects focus on a variety of interventions. For example, some projects compare culturally tailored tools with other tools for health education. Other projects test self-management techniques, which empower patients to participate in their own care. One study in Alabama will assess chronic pain and depression in African-American patients who do or do not receive cognitive behavioral therapy to improve self-management.
Some studies are exploring how to use technology to improve the quality of healthcare being delivered to diverse populations. For example, investigators in California are developing a culturally tailored intervention to educate Asian American patients on hepatitis B and C screening.
In addition to continuing to fund projects on topics selected by researchers, PCORI requests proposals to address specific health conditions and/or populations. The first topic-specific PCORI Funding Announcement (PFA) called for research to explore treatment options for uncontrolled asthma among African Americans and Hispanics/Latinos. In response to that announcement, our Board of Governors approved a total of $23.2 million in funding for eight awards.
PCORI-Funded Projects to Decrease Rates of Uncontrolled Asthma Among African Americans and Hispanics/Latinos
Specific Opportunities for the Near Future
The Addressing Disparities program is working on several other topic-specific funding opportunities in 2014 and 2015. Each announcement focuses on CER to reduce disparities for racial and ethnic minorities. We encourage proposals aimed at multi-level clinical interventions and promising practices:
- Obesity Treatment Options Set in Primary Care for Underserved Populations. Obesity disproportionately affects racial and ethnic minorities, including African Americans, Hispanic/Latinos, and American Indians. There has been little research that compares the effectiveness of different lifestyle changes for combating obesity, especially for racial and ethnic minorities and rural populations. We will accept applications for this announcement in May 2014, and awards will be selected for funding in September 2014.
- Integration of Mental and Behavioral Health Services into the Primary Care of Persons at Risk for Disparities in Healthcare and Outcomes. Racial and ethnic minorities are disproportionately affected by mental health disorders. The integration of mental health and primary care is important because it promotes early identification and treatment of mental illness and co-occurring disorders and improves access to care. This topic is included in PCORI’s announcement on Pragmatic Clinical Studies and Large Simple Trials. The deadline for Letters of Intent is June 27, 2014.
- Reduction of Cardiovascular Disease Risk in Underserved Populations, Such as Racial and Ethnic Minorities and Those Living in Rural Communities. Effective interventions to reduce racial and ethnic disparities in cardiovascular disease have not been widely reported but are critical to lessen the well-known disparities in cardiovascular morbidity, mortality, and prevalence. This topic is included in PCORI’s announcement on Pragmatic Clinical Studies and Large Simple Trials. The deadline for Letters of Intent is June 27, 2014.
We recognize that funding such research is just a start. Not only do we plan to identify additional areas where high-impact research can reduce racial, ethnic, and other disparities, but we also plan to focus on disseminating findings in partnership with patients, caregivers, and other stakeholders. Let us know what areas you consider most important for future research and share ideas about novel means to disseminate important research findings.