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Aronson J.,New York University | Burgess D.,University of Minnesota | Burgess D.,Center for Chronic Disease Outcomes Research | Phelan S.M.,University of Minnesota | Juarez L.,New York University
American Journal of Public Health | Year: 2013

Stereotype threat is the unpleasant psychological experience of confronting negative stereotypes about race, ethnicity, gender, sexual orientation, or social status. Hundreds of published studies show how the experience of stereotype threat can impair intellectual functioning and interfere with test and school performance. Numerous published interventions derived from this research have improved the performance and motivation of individuals targeted by low-ability stereotypes. Stereotype threat theory andresearchprovideauseful lens for understanding and reducing the negative health consequences of interracial interactions for African Americans and members of similarly stigmatized minority groups. Here we summarize the educational outcomes of stereotype threat and examine the implications of stereotype threat for health and healthrelatedbehaviors. Copyright © 2012 by the American Public Health Association®.

Burgess D.J.,Center for Chronic Disease Outcomes Research | Burgess D.J.,University of Minnesota | Yeazel M.W.,University of Minnesota | Hellerstedt W.L.,University of Minnesota
Obesity Reviews | Year: 2015

The objective of this study was to critically review the empirical evidence from all relevant disciplines regarding obesity stigma in order to (i) determine the implications of obesity stigma for healthcare providers and their patients with obesity and (ii) identify strategies to improve care for patients with obesity. We conducted a search of Medline and PsychInfo for all peer-reviewed papers presenting original empirical data relevant to stigma, bias, discrimination, prejudice and medical care. We then performed a narrative review of the existing empirical evidence regarding the impact of obesity stigma and weight bias for healthcare quality and outcomes. Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide. Experiences of or expectations for poor treatment may cause stress and avoidance of care, mistrust of doctors and poor adherence among patients with obesity. Stigma can reduce the quality of care for patients with obesity despite the best intentions of healthcare providers to provide high-quality care. There are several potential intervention strategies that may reduce the impact of obesity stigma on quality of care. © 2015 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of International Association for the Study of Obesity (IASO).

Kehle S.M.,Center for Chronic Disease Outcomes Research
Journal of general internal medicine | Year: 2011

To conduct a systematic review to address the following key questions: (1) what interventions have been successful in improving access for veterans with reduced health care access? (2) Have interventions that have improved health care access led to improvements in process and clinical outcomes? OVID MEDLINE, CINAHL, PsychINFO. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language articles published in peer-reviewed journals from 1990 to June 2010. All interventions designed to improve access to health care for US veterans that reported the impact of the intervention on perceived (e.g., satisfaction with access) or objective (e.g., travel time, wait time) access were included. APPRAISAL AND SYNTHESIS METHODS: Investigators abstracted data on study design, study quality, intervention, and impact of the intervention on access, process outcomes, and clinical outcomes. Nineteen articles (16 unique studies) met the inclusion criteria. While there were a small number of studies in support of any one intervention, all showed a positive impact on either perceived or objective measures of access. Implementation of Community Based Outpatient Clinics (n = 5 articles), use of Telemedicine (n = 5 articles), and Primary Care Mental Health Integration (n = 6 articles) improved access. All 16 unique studies reported process outcomes, most often satisfaction with care and utilization. Four studies reported clinical outcomes; three found no differences. Included studies were largely of poor to fair methodological quality. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Interventions can improve access to health care for veterans. Increased access was consistently linked to increased primary care utilization. There was a lack of data regarding the link between access and clinical outcomes; however, the limited data suggest that increased access may not improve clinical outcomes. Future research should focus on the quality and appropriateness of care and clinical outcomes.

Engasser H.C.,Center for Chronic Disease Outcomes Research | Warshaw E.M.,University of Minnesota
Journal of the American Academy of Dermatology | Year: 2010

Background: Although dermatoscopy is widely used in Europe and Australia, little is known about dermatoscopy use by US dermatologists. Objective: We sought to estimate the prevalence of dermatoscopy use by US dermatologists and examine associations with practice characteristics. Methods: We conducted a cross-sectional survey of all US fellows of the American Academy of Dermatology. Results: Of 8501 eligible recipients, 3238 (38.1%) surveys were completed and returned. Of respondents, 48% used dermatoscopy (n = 1555). Dermatoscopy use was associated with the following characteristics: age younger than 50 years (P < .0001), female sex (P = .0001), practice location in the Northeast (P < .0001), involvement in resident teaching (P < .0001), and dermatoscopy training (P < .0001). The main reasons for not using dermatoscopy included: lack of training (39.7%), lack of interest (32.5%), time required for dermatoscopic examination (27.6%), and belief dermatoscopy would not affect clinical decisions (15.2%). Limitations: Low response rate and potential response bias were limitations. Conclusions: Approximately half of respondents used dermatoscopy in their practice. Not surprisingly, dermatoscopy users were more likely to be younger, involved in resident teaching, or have training in dermatoscopy. © 2009 by the American Academy of Dermatology, Inc.

Partin M.R.,Center for Chronic Disease Outcomes Research
Journal of general internal medicine | Year: 2012

Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample. Observational Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009. We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities. Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9-32 %, p<0.0001) and region (12-23 %, p< .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %-5 %, p= .0492), but overuse after other procedures increased (11-19 %, p= .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p<0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months. Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.

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