PCORI Answers Critical Questions
Disparities are caused by complex and often interrelated factors that take place at the personal, family, community, provider, health system, state, and national levels. PCORI recognizes that disparities occur in many populations, including racial and ethnic minorities; people in rural locations; people with low incomes or low socioeconomic status; people with disabilities; lesbian, gay, bisexual, and transgender people; and people with limited English proficiency. PCORI is funding comparative clinical effectiveness research that will provide answers to questions such as:
Caregiver: I live in a rural town far from specialty clinics, but I want the best life for my son with Down syndrome. Would telemedicine at home provide him with the same quality of care he receives when we travel all the way to the doctor’s office?
Payer: Are there evidence-based smoking cessation treatments that take into account personal characteristics, such as age, gender, and cultural background?
Clinician: I have several transgender patients who are interested in gender reassignment therapies. What are the chances of benefits and harms of estrogen and testosterone therapies? Do the therapies increase my patients’ risk for cancer or stroke?
Study Results that Support Better-Informed Decisions
Advance care planning helps people with serious illnesses prepare for their future healthcare needs. But there are barriers that make it challenging, including a lack of planning materials and information available in Spanish. This study showed that a culturally tailored, Spanish version of a website called PREPARE encouraged Spanish-speaking patients to do advance care planning better than giving them only written forms to state their wishes. The website also enabled them to begin planning on their own without a need for healthcare staff.
Nearly 1 million people in the United States have Parkinson’s disease, and many of them do not live near a specialist who can help treat their disease. This project found that videoconferencing was a convenient way for people with Parkinson’s disease to get care from specialists.
Latino children with mental illness are half as likely to get mental health care as non-Latino white children. This study created an education program to teach Latino parents skills to get their the mental health care they need. Researchers found that the educational program improved parents’ knowledge and confidence about getting their child care, as well as their skills for working with their children’s schools.
Addressing Disparities Study Spotlights
Asian Americans make up five percent of the population, but have half of the cases of chronic hepatitis B virus infection in the United States. This study compares usual care to care that also uses a patient navigator and text messaging to see which approach more effectively improves health outcomes and reduces health gaps.
Buy-in from the community is key for researchers attempting to address health disparities. A PCORI-funded researcher working in rural Appalachian Kentucky, where cardiovascular disease rates are among the nation’s worst, says that having access to community health workers who can disseminate results that patients will trust is "fabulously effective."
Native Americans have the highest rate of diabetes among all US racial and ethnic groups. This study is examining a health project in which trained laypeople, known as community health representatives, reach out to coach people in their communities and help coordinate care.