The proposal addresses the observed disparities in treatments and outcomes experienced by persons with RA who are members of racial and ethnic minorities, have low levels of English language proficiency, and are of lower socioeconomic status. The proposal also addresses the observation that persons with RA with a primary language other than English and those born outside the U.S. experience a greater discordance between their assessments of disease activity and those of their providers. The overarching aim of the proposed project is to improve communication between patients with RA and their providers about disease activity and treatment choices. It is hypothesized that improved communication may provide a method of improving access to treatments of proven effectiveness for RA and in so doing reduce differences in outcomes.
The specific aims of the proposed D&F are to: 1) assess the quality of information exchange between patients and providers regarding disease activity and treatment choices in RA in a cohort of diverse patients;2) develop a computerized tool to improve communication about patient-reported symptoms and treatment preferences;and, 3) provide a preliminary assessment of the utility of the tool in terms of its feasibility in a clinical environment and the congruence between patients and providers in the symptoms addressed in an encounter by conducting a small pilot randomized trial.
The specific aims will be achieved by analysis of data from the RA Outcomes Study (RA-OS). The RA-OS includes a uniquely diverse set of 450 respondents. The first annual survey of the RA-OS will include items to obtain the data for Aim 1. The information from the analysis of the survey data will be combined with information from focus groups among members of the RA-OS and physicians and that from conscientious literature reviews to develop the computerized tool in Aim 2.
In Aim 3, 50 members of the RA-OS will participate in the pilot trial of the tool administered in a clinic visit. The overall goal of the project is to improve the quality of communication between patients with RA and providers and, therefore, reduce disparities in RA outcomes by improving patients'understanding of the disease and its treatments.

Public Health Relevance

Prior investigations have revealed substantial differences by race/ethnicity in the treatments received for RA and in RA outcomes;another investigation found discordance between patients and providers in the assessment of disease activity, with the discordance greater for patients who are non-English speakers and immigrants. The proposed project is designed to develop a tool to improve communication between patients and providers with the goal of reducing the discordance that may result in disparities in treatment.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Comprehensive Center (P60)
Project #
2P60AR053308-06
Application #
8293907
Study Section
Special Emphasis Panel (ZAR1-KM (M1))
Project Start
Project End
Budget Start
2012-05-11
Budget End
2013-04-30
Support Year
6
Fiscal Year
2012
Total Cost
$82,604
Indirect Cost
$29,139
Name
University of California San Francisco
Department
Type
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Gianfrancesco, M A; Balzer, L; Taylor, K E et al. (2016) Genetic risk and longitudinal disease activity in systemic lupus erythematosus using targeted maximum likelihood estimation. Genes Immun 17:358-62
Deng, Yun; Zhao, Jian; Sakurai, Daisuke et al. (2016) Decreased SMG7 expression associates with lupus-risk variants and elevated antinuclear antibody production. Ann Rheum Dis 75:2007-2013
Wysham, Katherine D; Murray, Sara G; Hills, Nancy et al. (2016) Cervical Spine Fracture and Other Diagnoses Associated with Mortality in Hospitalized Ankylosing Spondylitis Patients. Arthritis Care Res (Hoboken) :
Zhao, Jian; Giles, Brendan M; Taylor, Rhonda L et al. (2016) Preferential association of a functional variant in complement receptor 2 with antibodies to double-stranded DNA. Ann Rheum Dis 75:242-52
Ferguson, S; Trupin, L; Yazdany, J et al. (2016) Who receives contraception counseling when starting new lupus medications? The potential roles of race, ethnicity, disease activity, and quality of communication. Lupus 25:12-7
Katz, Patricia P; Barton, Jennifer; Trupin, Laura et al. (2016) Poverty, Depression, or Lost in Translation? Ethnic and Language Variation in Patient-Reported Outcomes in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 68:621-8
Yelin, Edward; Yazdany, Jinoos; Trupin, Laura (2016) Relationship between Process of Care and Subsequent Increase in Damage in SLE. Arthritis Care Res (Hoboken) :
Cruz, Giovanna I; Shao, Xiaorong; Quach, Hong et al. (2016) A Child's HLA-DRB1 genotype increases maternal risk of systemic lupus erythematosus. J Autoimmun 74:201-207
Murray, Sara G; Schmajuk, Gabriela; Trupin, Laura et al. (2016) National Lupus Hospitalization Trends Reveal Rising Rates of Herpes Zoster and Declines in Pneumocystis Pneumonia. PLoS One 11:e0144918
Baker, Joshua F; Long, Jin; Ibrahim, Said et al. (2015) Are men at greater risk of lean mass deficits in rheumatoid arthritis? Arthritis Care Res (Hoboken) 67:112-9

Showing the most recent 10 out of 171 publications