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Quiñones AR, O'Neil M, Saha S, et al. Interventions to Improve Minority Health Care and Reduce Racial and Ethnic Disparities [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011 Sep.

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Interventions to Improve Minority Health Care and Reduce Racial and Ethnic Disparities [Internet].

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APPENDIX DEVIDENCE TABLE

Author, Year, EN IDClinical topicPopulationSettingSingle-race (included only minority study participants)Comparative (included minority and majority participants with pre and post intervention comparison)Mostly generic or tailored interventions?Study methodology (e.g., systematic review, metaanalysis)Study period/search datesNumber and hierarchy of studies includedIntervention types (i.e., community health workers)
Primary Studies
Chang, 20091PreventiveVeterans
n=183 patients
71% black, 29% white
Urban VAMC (Washington DC)NoYes. Multiple groups, but do not analyze pre-post by raceGenericPrimary article; retrospective chart review of HBPC enrollees. Pre-post enrollment (no control)Patients enrolled for at least 6 months during the period of January 2001-December 2002n/aMultiprofessional home-based primary care (HBPC) team: medical director, nurse practitioners, registered nurses, social workers, pharmacists, registered dietician, dental hygienist and program director.
Dang, 20074PreventiveVeterans age 60 or older
n=41 patients
n=21 white (51%)
n=14 black (34%)
n=6 Hispanic (15%)
Urban VAMC (Miami)NoYesGenericPrimary study (pre-post no control group)Patients enrolled for at least 9 months from May 2000-January 2002n/aCare coordination: 2 care coordinators (nurse pract, licensed clin social worker), secretary and geriatrician (oversight)
Telemedicine: telephone-based in-home messaging device for patient monitoring. Patients input blood sugar levels and answer educational questions. Data transmitted to messaging center, stratified into high/med/low risk for care coordinators following morning.
Dang, 20082Mental healthVeterans with dementia (MMSE < 25) and live-in caregivers; white = 72, AA = 32, Hispanic = 9.Homes of caregivers/recipients.NoYes. Multiple groups, but do not analyze pre-post by raceGenericPrimary article; pre-post with no control groupn/an/aScreen telephones and support by care coordinators.
Shore, 20083Mental healthAmerican Indian Vietnam VeteransIn person and telephone interviewsYesNoTailoredPrimary article; tests of mean differences, comparisons of kappas.n/an/aTelephone and in person interviews to test the feasibility of SCID in this population/setting
Weng, 20075Pain/arthritisAfrican American and white male Veterans n=102 patients at baseline (n=54 black and n=48 white) n=64 completed followup questionnaire (n=33 black, n=31 white)Urban VAMC (Greater Los Angeles)NoYesTailoredPrimary study (pre-post no control group)n/an/aEducational videotape and tailored total knee replacement (TKR) decision aid
Systematic Reviews
Anderson, 200340Cross-cuttingMinorities onlyAll medical settingsYes. Most included studies are single-race.NoTailoredSystematic review1965-20016 RCTsClinician bias: recruitment/retention of diverse staff, interpreter services, cultural competence training, ed materials, culturally specific health care settings.
Beach, 200539Cross-cuttingHealth professionals and ethnic minority patientsn/aYes. Most included studies are single-race.NoTailoredSystematic review1980 through 2/20032 RCTs, 12 controlled, 20 pre-post.Training programs varying in lengths generally effective in improving certain aspects of provider characteristics.
Beach, 200638PreventivePhysicians, nurses and medical assistants and emergency medical personnel.Hospital outpatient
Community health center
Group practice
Community care
Yes. Some included studies are single-race.Yes. Most included studies are comparative.TailoredSystematic review1980-June 2003n=27
RCT n=20
CCT n=7
Tracking/reminder systems, bypassing the physician, safe times questionnaires for pts, remote simultaneous translation
Corcoran, 201013PreventiveLatinas in the USCommunity (6) and clinic (3) settings in California, Texas, New Mexico, Colorado and WashingtonYes. All included studies are single-race.NoTailoredMeta-analysisended January 2009n=9
Quasi-experimental n=6
RCT n=3
Lay-health advisor (promotoras), printed mailings, educational groups, television campaigns, access-enhancing (1 study)
Crepaz, 200731HIV/AIDSBlack and Hispanic STD Clinic PatientsSTD ClinicsNoYes. Some included studies are comparative, but do not analyze pre-post by race.TailoredMeta-analysis1998-june 200518 RCTsIntervention delivered by health educator/counselor
Crepaz, 200930HIV/AIDSAfrican American FemalesHealth Care and Community SettingsYesYes. Some included studies are comparative, but do not analyze pre-post by race.TailoredMeta-analysisJanuary 1988 to June 200737 individual and groups level intervention studies and 4 community level intervention studies.Patient activation
Crook, 200928CVDAfrican-AmericansAmbulatory care and community settingsYesNoGenericSystematic review1996 - 2006NRCounseling/education for behavior change; screening; changes in delivery system; exercise, stress reduction, dietary modification
Davis, 200727CVDMinorities and whitesCommunity and health care settings. Interventions had to be connected to health care organizations.Yes. Most included studies are single-race.Yes. Some included studies are comparative, but do not analyze pre-post by race.GenericSystematic review1995 - 2006Overall: 52 RCT, 8 pre-post, 2 non-randomized controlled clinical trialsProvider and care delivery interventions (e.g., patient outreach, clinic reorganization, interventions with nurses alone or with community health workers included); patient and family interventions
Eyles, 2009 25PreventiveHealth or mixed-health status adults aged 18 to 85+Non-face-to-face methods of contacting participants. Of the US studies, 6 were conducted in community settings, 4 were conducted in clinical/health care settings and 2 did not report recruitment activities.Yes. One included study was single-race.YesTailoredMeta-analysis (and narrative summaries)January 1990-December 2007n=16
All studies were RCT or quasi-RCT
All studies included experimental group that received tailored nutrition education and control group with either generic and/or no nutrition education. 11 were conducted in the US, 1 was conducted in US and Canada
Tailored nutrition education included print, email or other non-face-to-face format (excluded studies that used face-to-face delivery methods)
Han, 200915PreventiveAdult Asian/PI, African American, Hispanic and white womenn=19 in community settings
n=4 in health care settings
Yes. Most included studies are single-race.Yes. Some included studies are comparative, but do not analyze pre-post by race.TailoredMeta-analysisSeptember 2000 - August 2008n=23
RCT n=14
All studies were experimental or quasi-experimental design. Evidence tables offered as supplemental online content
directed print materials, peer/lay health advisor education and support, telephone counseling.
Han, 201018PreventiveAdult women.
N=4 predominantly African American; N=3 mostly Hispanic; N=8 mostly Asian; N=1 mostly Native American; N=2 combination of Hispanic and African American
n=5 health care settings
n=13 community settings
Yes. Most included studies are single-race.YesGenericMeta-analysis1984-April 2009n=18
RCT n=9
Quasi-experimental non randomized n=9
  1. individual-directed (in-person and phone counseling)
  2. Access-enhancing (reduced cost, mobile vans)
  3. Peer-navigator (lay health advisors)
  4. Community education (small group workshops/seminars)
  5. Mass media (tv, newspaper, radio campaigns)
Hawthorne, 20106
Hawthorne 2008;7
DiabetesAll included studies were conducted in single-race groups. Some populations don't apply to US (e.g. South Asian British).Group and individual sessions in clinics, community medical centers, homes of participants, hospital and GP practices. Type of HE provider ranged from peer leaders, certified DM educators, bilingual nurse, CHW, podiatrist, dietician, exercise physiotherapist.Yes. All included studies were conducted in single-race groups.NoTailoredSystematic review and meta-analysis1966 or inception thru 200712 RCTsCulturally appropriate health education (group sessions in the majority of included studies) defined as HE tailored to the cultural or religious beliefs and linguistic and literacy skills of the community being studied.
Herbst, 200733HIV/AIDSHispanicsHealth/drug treatment clinics, schools, community based organizations, and farm worker campsitesYesNoTailoredMeta-analysis1988-200620 studies included in meta-analysisVariety of implementation methods from fotonovela to health educator/outreach worker
Johnson, 200932HIV/AIDSAfrican AmericansCommunity and clinical settingsYesYes. Most included studies are comparative, but do not analyze pre-post by race.TailoredMeta-analaysis1981-200678 RCTsHealth education
Lie, 201036Cross-cuttingAll patient populationsAll medical settingsYes. One included study was single-race.NoTailoredSystematic review1/1990-3/20102 quasi-randomized, 2 cluster randomized, 3 pre-post.Cultural competence curricula
Martinez-Donate, 2009 14PreventiveLatinas and non-Latinas in the USCommunity setting; majority of included studies in the West and Southwest USNoYesGenericSystematic reviewThrough August 2008N=14
RCT N=2
CCT N=6
Lay health advisors (education, phone counseling, media campaign, social support, community events, mobile screening)
Masi, 200716PreventiveMinority and white female patients (mostly African American and Hispanic), providersHealth care settingsYes. A few included studies are single-race.Yes. Most included studies are comparative.GenericSystematic review1986-December 2005n=43
(n=36 on screening, n=5 follow up testing, n=2 treatment, n=1 survivorship)

RCT n=33
CCT=10
Patient: reminder letters, telephone calls, written educational materials, in-person counseling, mammography vouchers, classroom education

Provider: chart reminders, chart flow sheets, written education materials, chart autids with feedback
Mau, 2009 29CVDNative Hawaiians and other Pacific Islanders (NHOPI)2 community based samples, 1 clinic sampleYesNoTailoredSystematic review1998 - 20082 pre-post, 1 nonrandomized controlled clinical trialOne study used community health workers to deliver a disease management program. Another study used group visits for hypertension counseling.
Morrow, 201020PreventiveMultiethnic groups in the US, including at least 1 disadvantaged groupCommunity-basedNoYesGenericSystematic review1/2001 - 8/2009N=15
All RCT
  1. Patient mailings (mailing, tailored mailing, tailored mailing & phone reminder, brochure); N=3
  2. Telephone outreach (scripted and unscripted phone assistance with mailings, care manager calls, tailored phone education); N=3
  3. Electronic and multimedia (physician email system, preferences-based website, standardized website, multimedia computer program education, peer education/health professional video education); N=4
  4. Community education (pts receiving navigator services, community screening behavior program, risk counseling, general counseling, cultural self-empowerment) N=5
Ngo-Metzger, 201053Cross-cuttingAsian American patients, though NO articles were found on this population.All medical settingsYesNoGenericSystematic review1/1994-7/2009None. Extrapolate from white patients.Some recommendations at end, none based on any evidence.
Norris, 200610DiabetesSR that includes 8 RCTs; each RCT a single-race group. Minority populations were the target of all studies but 2; majority of participants female and middle-aged.Unrestricted settings: community health workers could have delivered the intervention in the clinic, home or community setting, in either developed or undeveloped countries.YesNoGenericSystematic review1966 to March 200418 total:
8 RCTs, 6 before-after studies, 3 non-randomized allocation of treatment and comparison groups, 1 study with postintervention measures only
Community health workers serving in a variety of roles
O'Malley, 200317PreventiveLatino and white patientsPrimary care settings (community health clinic or doctor's offices)Yes. A few included studies are single-race.Yes. Some included studies are comparative, but do not analyze pre-post by race.GenericSystematic reviewJanuary 1985-January 2003n=14
RCT n=5
non-randomized controlled trial n=3
pre-post n=3
quasi-experimental n=3
Clinical reminders; peer health educators; culturally sensitive videos; audit with feedback; vouchers
Osei-Assibey, 201024PreventiveAdults (18 and older). African Americans, Hispanics, Japanese-Americans and white AmericansAll 19 included trials conducted in the US, though not specified if in community or health care settings.Yes. Most included studies are single-race.Yes. Some included studies are comparative.GenericSystematic reviewnot specifiedN=19
all RCT
Culturally tailored advice/diet counseling; individual programs; family/group programs; peer discussion groups; web-based program;
Peek, 20078Diabetes42 studies in which minority patients were >50% racial makeup, or subgroups of larger trials that were specifically described.Patient education settings included academic primary care clinics and community based health centers. Provider intervention settings included public hospital academic general internal medicine clinics and community based private physician practices. Health care organization interventions occurred in rural and urban locations, academic and community based primary care clinics, and a public hospital diabetes clinic.Yes. Most included studies are single-race.Yes. Some included studies are comparative, but the majority do not analyze pre-post by race.GenericSystematic review1985-200622 RCTs, 7 RCTs, 13 before/after studies, 1 observational study.Systematic review of patient-target interventions that sought to improve dietary habits, physical activity, or self-management activities; physician provider-target interventions; health care organization interventions; and multi-target interventions. Included culturally tailored programs.
Many health care organization interventions used a registered nurse for case management and/or clinical management via treatment algorithms, often with a CHF for peer support and community outreach. 2 studies evaluated pharmacist-led medication management and patient education.
Multi-target interventions involved more than one of the above targets, e.g. multidisciplinary teams.
Perez-Escamilla, 200826PreventiveLatinos in the USCommunity and health care settingsYes.No.TailoredSystematic reviewNot specifiedn=22
RCTn
Pre-post n=13
Cost-benefit n=1
RCTs: 2 in diabetes peer counseling; 2 breastfeeding; 1 food nutrition education
Pre-post: 7 in diabetes peer counseling; 2 in breastfeeding; 5 in food nutrition education
Peer educators; nutrition education; nurse case management
Powe, 201019PreventiveIndividuals aged 50+ and had a study sample of at least 50% African Americansprimary care settings and community based settingsYes. A few included studies are single-race.Yes. Most included studies are comparative, but do not analyze pre-post by race.GenericSystematic review2000-2008n=12
RCT n=8
Nonrandom n=4
Mailed personalized materials; reminder letters/calls; physician reminders; case manager calls; lay health advisors; tailored phone education; physician education
Sarkisian, 200311DiabetesStudies were in single-race groups only. 2 studies were aimed at older adults and did not specify race.Various: 1 urban hospital, 2 VA's, 1 rural NOS, 1 in Sweden, 1 in Cuba, others named by city NOS.YesNoGenericsystematic reviewJan 1985 - Dec 20008 RCTs
3 Uncontrolled trials using a before/after design
1 RCT but results were presented using before/after analysis
Self-care interventions that aimed to change the behavior of patients, rather than simply educating them. 4 studies were designed according to cultural criteria specific to the targeted group. Techniques for cultural tailoring included focus groups, and using specific recipes for the ethnic group being studied.
Saxena, 20079DiabetesUS populations in 4 studies. Two studies included both African Americans and Hispanics, and 1 study included only African Americans. 1 study appears to have included only Hispanic African Americans.Primary CareNoYes. Some included studies are comparative, but do not analyze pre-post by race.Genericsystematic reviewDatabase inception to December 20069 studies (4 in UK, 4 in US, 1 in Netherlands).
The 4 US studies included 2 RCTs and 2 CCTs.
Primary care interventions, including case management, patient counseling, and reminder cards to prompt providers
Van Voorhees, 200734Mental healthEthnic minorities and whites; all ages.Mostly primary care clinics.NoYes. Some included studies are comparative, but do not analyze pre-post by race.Tailoredsystematic review1/1995 through 1/200620 interventions total. 12 chronic disease management (9 multicomponent (8 RCTs, 1 observational/cohort) + 3 single component (1 RCT + 2 observational/cohort); 7 case management + 4 collaborative care) + 8 tailored (3 treatment programs + 4 preventive interventions + 1 psychoeducation).Case management by trained layperson, nurse, or social worker. Some ethnic matching.
Ward, 2007 35Mental healthEthnic minority and white women (n = 5027 with 2136 ethnic minorities)PCPs, MH clinics, WIC and other targeted service clinicsNoYesGenericSystematic review1981 through 200510 studies (7 RCTs, 1 observational retrospective design, 1 case series, 1 unclear).QI, case management, guideline-based interventions, collaborative care, standard psychotherapies, cultural adaptations to psychotherapies.
Webb, 200821PreventiveAfrican American and whitesClinical and communityNoYesGenericMeta-analysis1984-April 2006n=20
Studies coded as quasi-experimental or RCT, but not reported
Pharmacological (sustained-release bupropion, nicotine patches, nicotine lozenge); individual, phone and group behavioral counseling; targeted print materials; community outreach; video/radio media; multicomponent of above
Webb, 201022Preventivehealthy US Hispanic adultsHome visits, health care settings, community settingsYesNoGenericSystematic review and mini meta-analysis1991-2007n=17
n=12 for SR
RCT n=5 for MA
Self help; nicotine replacement therapy; community based interventions; individual counseling; group counseling; telephone counseling
Whitt-Glover, 200923PreventiveAfrican AmericansCommunity (churches, YMCA, community centers, public housing) and health care settings (doctor offices, hospitals)NoYesGenericSystematic reviewSeptember 2002-December 2006n=29 (additional n=14 on children are not considered here)-RC=-NCT=4 (non-randomized controlled trials-UCT=10 (uncontrolled trial)Telephone counseling; peer counselors; structured exercise program; group exercise sessions; unstructured/unsupervised exercise

Abbreviations: CHW – community health worker, CVD – cardiovascular disease, DM – diabetes mellitus, ESP – Evidence-based Synthesis Program, GP – general practitioner, HE – health education, HSR&D – Health Services Research and Development Service, MH – mental health, NOS – not otherwise specified, PCP – primary care provider, RCT – randomized controlled trial, VAMC – VA Medical Center, WIC - Special Supplemental Nutrition Program for Women, Infants and Children

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