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Principal Investigator: Lusine Poghosyan
Organization: COLUMBIA UNIVERSITY HEALTH SCIENCES
Fiscal Year: 2024
Award: $804,074
Funding agency: National Institute of Nursing Research
More than 80% of adults aged 65 and older in the United States have at least one chronic health condition.
Racial and ethnic minorities suffer more. They often lack high quality care and use hospitals and emergency
departments (EDs) for routine care. Where minorities reside and receive care contribute to health disparities.
They often live in disadvantaged neighborhoods, and social determinants of health (SDoH) lead to disparities.
Minorities also get care in low quality healthcare settings. Health disparities will further widen due to primary
care physician shortages. The growing nurse practitioner (NP) workforce can help reduce health disparities as
NPs disproportionately care for minorities. Yet, practices employing NPs (i.e., NP practices) are often located
in underserved communities and face major structural (e.g., lack of registries) and organizational (e.g., poor
care environments) challenges. The study’s overarching aim is to understand ways in which NP practices
could be leveraged to address SDoH and reduce health disparities. Building on our prior work, we will conduct
the first national mixed-methods study using multilevel models, geographic information system, and a positive-
deviance approach to achieve the aims: Aim 1. Investigate the impact of SDoH (i.e., economic stability,
education, built environment, health care access, and social context) on racial and ethnic disparities in quality
of care processes (e.g., HbA1c testing for diabetes) and outcomes (i.e., ED use, hospitalizations) among
chronically older adults receiving care in NP practices). Aim 2. Assess the extent to which NP practice
attributes (i.e., care environment, structural capabilities) moderate the impact of SDoH on racial and ethnic
disparities in quality of care processes and patient outcomes. Aim 3. Explore barriers and facilitators to
addressing SDoH and health disparities in NP practices with varying care environments and structural
capabilities. We will use existing data on neighborhoods and chronically ill Medicare patients cared for by NPs
in 2021-2022 in minority- and non-minority serving and integrated NP practices (n=2,400). We will also survey
NPs (n=6,960) in these practices on their care environments and structural capabilities using mail and online
methods. All data about patients, neighborhoods, NPs, and practices will be merged and analyzed in multilevel
models. We will also identify practices with favorable and unfavorable care environments and structural
capabilities and interview NPs and practice managers using positive-deviance methods. We will conduct
individual telephone/online interviews with ~50 NPs and ~50 practice managers from practices with favorable
and ~35 NPs and ~35 managers from practices with unfavorable attributes. The interviews will be recorded
and transcribed for content analysis. We will identify modifiable factors in practices to address SDoH. In all
study aims, we will oversample minority-serving NP practices. Our quantitative and qualitative findings will be
triangulated to inform administrators and policymakers seeking ways to leverage NP practices to address
SDoH and reduce racial and ethnic health disparities through practice, policy, and neighborhood interventions.
Terms: <21+ years old><65 and older><65 or older><65 years of age and older><65 years of age or more><65 years of age or older><65+ years><65+ years old><> 65 years><Accident and Emergency department><Address><Administrator><Adult><Adult Human><Affect><Aged 65 and Over><Area><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Care given by nurses><Caring><Chronic><Chronic Care><Chronically Ill><Community Services><Competence><Coupled><Data><Decrease health disparities><Diabetes Mellitus><Disparities><Disparity><Economics><Education><Educational aspects><Elderly><Emergency Department><Emergency room><Ensure><Environment><Face><Future><Gene Transcription><Genetic Transcription><Geographic Information Systems><Glycohemoglobin A><Glycosylated hemoglobin A><Hb A1><Hb A1a+b><Hb A1c><HbA1><HbA1c><Health><Health Care Systems><Health Insurance for Aged and Disabled, Title 18><Health Insurance for Disabled Title 18><Health Services><Health Status><Health disparity mitigation><Health disparity reduction><Healthcare><Healthcare Provider Shortage Areas><Healthcare Systems><Hemoglobin A(1)><Hospital Admission><Hospital Departments><Hospitalization><Hospitals><Individual><Insurance Carriers><Insurers><Intervention><Intervention Strategies><Interview><Investments><Lead><Level of Health><Lower health disparities><Medicare><Medicare claim><Methods><Minority><Mitigate health disparities><Modeling><Neighborhoods><Nurse Practitioners><Nursing Care><Outcome><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pb element><Persons><Phone><Play><Policies><Policy Maker><Population><Primary Care><Primary Care Physician><Primary Nursing Care><Process><Public Health><QOC><Quality of Care><RNA Expression><Reduce health disparities><Registries><Reminder Systems><Research Resources><Resources><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Sampling><Service delivery model><Service model><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Social Environment><Structure><Survey Instrument><Surveys><System><Telephone><Testing><Title 18><Transcription><Translating><US State><United States><Work><above age 65><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><adulthood><advanced age><after age 65><age 65 and greater><age 65 and older><age 65 or older><age > 65><age of 65 years onward><aged 65 and greater><aged 65+><aged ≥65><behavioral health><built environment><care delivery><care delivery model><care for patients><care of patients><care services><care systems><caring for patients><clinical care><community level disadvantage><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><design><designing><diabetes><disadvantaged community><disease registry><disparities in race><disparity due to race><disparity in ethnic><disparity in health><economic><elderly patient><ethnic based disparity><ethnic disadvantage><ethnic disparities in health><ethnic disparity><ethnic health disparity><ethnic inequality><ethnic inequity><ethnic minority><ethnicity disparity><faces><facial><geospatial information system><geriatric><health care><health care access><health care availability><health care delivery model><health care professional shortage areas><health care quality><health care service access><health care service availability><health care settings><health data><health disparity><health equity><health insurance for disabled><health level><health professional shortage areas><healthcare access><healthcare accessibility><healthcare availability><healthcare delivery model><healthcare quality><healthcare service access><healthcare service availability><healthcare settings><heavy metal Pb><heavy metal lead><hemoglobin A1c><human old age (65+)><improved><inequality due to race><inequity due to race><innovate><innovation><innovative><intervention design><interventional strategy><methods to study multiple-level influences><minority patient><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><neighborhood barrier><neighborhood disadvantage><neighborhood-level barrier><neighborhood-level disadvantage><old age><older adult><older adulthood><older patient><over 65 years><patient oriented outcomes><patients from minority><patients of minority><payment><population health><prevent><preventing><primary care practice><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparities in health><racial disparity><racial health disparity><racial inequality><racial inequity><racial minority><racially unequal><routine care><senior citizen><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social climate><social context><social group><social health determinants><social role><socioenvironment><socioenvironmental><therapy design><treatment design><under served area><under served community><under served geographic area><under served location><under served region><underserved area><underserved community><underserved geographic area><underserved location><underserved region><≥65 years>