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Associations of race with depression and symptoms in patients on maintenance haemodialysis Nephrol Dial Transplant; 01/01/2007; 22: 1 (203 - 208)
Weisbord SD, Fried LF, Unruh ML, Kimmel PL, Switzer GE, Fine MJ, Arnold RM CHERP Investigator(s):
Steven Weisbord MD, MSc • Linda F Fried MD, MPH • Galen E Switzer PhD • Michael J Fine MD, MSc • Summary:
Although studies have shown that African American haemodialysis patients report better overall quality of life than Whites, racial differences in depression and symptom burden remain less well characterized. We surveyed African American and White maintenance haemodialysis patients. Among the 82 Whites and 78 African Americans enrolled, there were no racial differences in the prevalence of depression (27% in African Americans vs 27% in Whites, P = 1.0), BDI Scores (11.2 vs 10.9, P = 0.6) or CDI scores (6.0 vs 6.0, P = 0.9). Symptom burden was substantial in both African Americans and Whites (median number of symptoms 8.5 and 9.0, respectively) with no racial differences in the overall burden or severity of symptoms. However, based on a single item, African Americans were more likely to describe their religious/spiritual beliefs as "very important". Adjustment for demographic and treatment characteristics had no impact on the associations of race with depression or symptoms. Depression and symptoms are highly prevalent in both African American and White haemodialysis patients, without racial differences in these health-related domains.
Clinical concerns about clinical performance measurementAnn Fam Med; 03/01/2007; 5: 2 (159 - 163)
Werner RM, Asch DA CHERP Investigator(s):
Rachel Werner MD, PhD • David A Asch MD, MBA •
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Knee Replacement Disparity: A Randomized, Controlled Intervention
Started: 05/01/2006
Status: Data Collection
Objectives:
The short-term goals of this randomized, controlled trial are to demonstrate the efficacy of interventions to improve understanding of knee replacement risks, benefits, and expected outcomes among African-American primary care patients, increase willingness to consider knee replacement among African-American primary care patients, and increase primary care referral rates for surgical consideration for African-American patients who meet the indications for knee replacement.
CHERP Investigator(s):
Said A Ibrahim MD, MPH (PI) •
Cost Effective Strategy to Evaluate Veterans with Sleep Apnea
Started: 05/01/2006
Status: Data Collection
Objectives:
The purpose of this study is to compare the cost and benefits of diagnosing patients with obstructive sleep apnea and starting them on treatment using either portable monitors that patients use in their homes, or sleep studies performed in the sleep laboratory. The goal is to improve access to care for veterans with suspected obstructive sleep apnea.
Dr. Kuna and his team have implemented a prospective randomized control trial of equivalency among patients referred to the Philadelphia and the Pittsburgh VAMCs for evaluation for obstructive sleep apnea. Patients are randomized to either exclusively in-lab or home testing following baseline assessment. In-lab testing includes polysomnograms to diagnose obstructive sleep apnea and titrate the pressure setting for subsequent CPAP treatment. The self-administered home testing consists of an overnight unattended sleep study followed by a 1-week auto-CPAP titration trial. Patients are assessed for CPAP adherence and its consequent effects on subjective and objective daytime sleepiness, disease specific and general functional impairment, and patient preference at regular intervals after initiation of CPAP treatment. Medical service use and cost will be collected for the entire two-year observation period.
The goal is to recruit 132 patients at each study site. As of April 2007, the Philadelphia VAMC has successfully enrolled 41 patients and 15 are receiving CPAP treatment. At the Pittsburgh VA Healthcare System, the team has enrolled 26 patients and 1 is on CPAP treatment.
CHERP Investigator(s):
Samuel Kuna MD, MCSE (PI) •
Improving Patient-Provider Communication for Colorectal Cancer Screening
Started: 05/01/2006
Status: Data Collection
Objectives:
This study will assess the effectiveness of an intervention to advance patient-provider communication about colorectal cancer screening in improving patient adherence with colorectal cancer screening recommendations.
CHERP Investigator(s):
Bruce S Ling MD, MPH (PI) •
The Role of Performance Measurement in Improving Health Care Quality
Started: 05/01/2006
Status: Career Award
Objectives:
Through this Career Development Award Dr. Werner will investigate how the transformation of the VA health care system affects patient outcomes and health care delivery. One project will be a longitudinal analysis of the relationship between quality improvements at the VA and patient outcomes using VA data. A second project will be an analysis examining the cost-quality tradeoff of quality improvement initiatives undertaken at the VA.
CHERP Investigator(s):
Rachel Werner MD, PhD (PI) •
Barriers to Initiating Antiviral Therapy for Veterans with Hepatitis C
Started: 05/01/2006
Status: Data Collection
Objectives:
This study will provide novel and important insights into the complexities that contribute to the low treatment rates among veterans infected with hepatitis C. The results of this study will enable us to design behavioral interventions to increase patient willingness to pursue HCV treatment, and to better inform healthcare providers about the specific needs of this patient population.
CHERP Investigator(s):
Susan Zickmund PhD (PI) •
The PRIDE implementation project (Promoting Residents' Involvement in Decisions at End-of-life)
Started: 05/01/2006
Status: Data Collection
Objectives:
This project will support and coordinate the nationwide implementation of the PRIDE intervention, which has been proven to improve hospice access and end of life care and decrease ethnic disparities in nursing homes.
CHERP Investigator(s):
David J Casarett MD, MA (PI) •
Ethnicity and Culture in Unrelated Stem Cell Donation
Started: 05/01/2006
Status: Data Collection
Objectives:
This study will examine the role of culturally-based traditions/beliefs (e.g., medical mistrust, religious beliefs) in (a) potential donors' decisions of whether or not to donate hematopoietic stem cells (HSCs), and (b) the health experiences of unrelated donors who actually donate HSCs.
CHERP Investigator(s):
Galen E Switzer PhD (PI) •
Longitudinal Impact of CNS Polypharmacy on Geriatric Syndromes
Started: 05/01/2006
Status: Data Collection
Objectives:
The long-term objective of this project is to enhance the health of the elderly by determining the dynamic effects over time of exposure and changes in CNS polypharmacy on geriatric syndromes, so that interventions can be designed, health outcomes improved and health care costs reduced. Using a longitudinal design, the immediate objective is to determine the impact over time of CNS polypharmacy on geriatric syndromes.
CHERP Investigator(s):
Joseph Hanlon PharmD, MS (PI) •
Understanding and Reducing Racial Disparities in Renal Transplantation
Started: 06/01/2006
Status: Data Collection
Objectives:
African-Americans (AA) are disproportionately affected by end-stage renal disease (ESRD). While living donor kidney transplantation is the optimal treatment for ESRD, AAs are much less likely to identify a living donor, or receive a living donor kidney transplant. Given the importance of cultural variables in other disease settings and their potential to explain disparities in the context of transplantation, this mixed-method prospective cohort pilot study will focus on these issues. Specific goals are to: (1) demonstrate our ability to recruit and retain ESRD patients in a longitudinal study; (2) examine the acceptability of the proposed quantitative and qualitative measures using telephone interview procedures; (3) describe patients along four dimensions, including culturally-based, psychosocial, cognitive, and demographic characteristics; and, (4) estimate the magnitude of associations (effect sizes) among key study variables.
CHERP Investigator(s):
Larissa Myaskovsky PhD (PI) •
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