Research

The effect of ethnicity on outcomes in a practice-based trial to improve cardiovascular disease prevention

Paul J Nietert¹ , Steven M Ornstein² , Ruth G Jenkins² , Loraine F Roylance² , Lori M Dickerson² and Chris Feifer³

¹  Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, 135 Cannon St., Suite 403, P.O. Box 250837, Charleston, SC 29425 USA

²  Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425 USA

³  Department of Family Medicine, University of Southern California, 1000 S. Fremont Ave., Bldg. A7, Rm. 7419, Alhambra, CA 91803 USA

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International Journal for Equity in Health 2004, 3:12doi:10.1186/1475-9276-3-12

Published:	7 December 2004

Abstract

Background

Health disparities are a growing concern. Recently, we conducted a practice-based trial to help primary care physicians improve adherence with 21 quality indicators relevant to the primary and secondary prevention of cardiovascular disease and stroke. Although the primary concern in that study was whether patients in intervention practices outperformed those in control practices, we were also interested in determining whether minority patients were more, less, or just as likely to benefit from the intervention as non-minorities.

Methods

Baseline (fourth quarter 2000) and follow-up (fourth quarter 2002) data were obtained from 3 intervention practices believed to have at least 10% minority representation. Two practices had a black (non-Hispanic) population sufficient for analysis, while the other had a sufficient Hispanic population. Within each practice, changes in the 21 indicators were compared between the minority patient population and the entire patient population. The proportion of measures in which minority patients exhibited greater improvement was calculated for each practice and for all 3 practices combined, and comparisons were made using non-parametric methods.

Results

For all black patients, the observed improvement in 50% of 22 eligible study indicators was better than that observed among all white patients in the same practices. The average changes in the study indicators observed among the black and white patients were not significantly different (p = 0.300) from one another. Likewise for all minority patients in all 3 practices combined, the observed improvement in 14 of 29 (43.3%) eligible study indicators was better than that observed among all white patients. The average changes in the study indicators among all minority patients were not significantly different from the changes observed among the white patients (p = 0.272).

Conclusions

Among 3 intervention practices involved in a quality improvement project, there did not appear to be any significant disparity between minority and non-minority patients in the improvement in study indicators.