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"Iezzoni, Lisa I"
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Multiple sclerosis
Describes how this frequently disabling disease affects patients, exploring its effects on minds, bodies, and daily lives.
Book
Experiences of researchers with disabilities at academic institutions in the United States
People with disabilities are underrepresented in higher education, facing systematic obstacles such as inaccessible communication and physical environments and difficulties obtaining accommodations. This study aims to shed light on barriers to accessibility and disability inclusion in research institutions through confidential qualitative interviews with researchers with disabilities.
We recruited participants via virtual flyers. Eligibility criteria included working in the United States (U.S.) as researchers that had applied for grant funding (last five years), and self-identifying as having a disability. We offered participants (total n = 35) the option of either semi-structured one-on-one live or written interviews based on their preference. Two study team members analyzed written and live responses using thematic analysis to identify themes.
Themes included identity/visibility, career trajectories, accessibility, accommodations, bias, representation, and inclusion. Some participants reported not disclosing their disabilities at work or during hiring processes due to fear of negative perceptions from peers or potential employers. Experiences around stigma and bias were noted both in professional relationships and when interacting with disability service offices, underscoring difficulties and delays in processes to secure accommodations. Respondents highlighted the lack of disability inclusion and low representation of people with disabilities in academia and elevated the importance of self-advocacy and of role models and mentors in shaping career pathways for future researchers with disabilities.
Researchers with disabilities encounter systematic barriers at academic institutions, and lack of acknowledgement and research on these experiences has held back institutional and policy changes. To reduce disparities for researchers with disabilities, academic leadership must allocate resources to address ableism, create more inclusive environments, and raise standards beyond compliance with the Americans with Disabilities Act.
Journal Article
Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients
Studies documenting racial/ethnic disparities in health care frequently implicate physicians' unconscious biases. No study to date has measured physicians' unconscious racial bias to test whether this predicts physicians' clinical decisions.
To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.
An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.
IAT scores (normal continuous variable) measuring physicians' implicit race preference and perceptions of cooperativeness. Physicians' attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians' explicit racial biases by questionnaire.
Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians' prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).
This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians' unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
Journal Article
Variability in the Measurement of Hospital-wide Mortality Rates
This study showed that four commonly used methods to calculate hospitals' risk-adjusted rates of death produced different results. The same hospitals were classified as having higher-than-expected mortality by one method and lower-than-expected mortality by other methods.
Hospital-performance metrics are increasingly used for value-based purchasing and public reporting. For example, Section 3001 of the Patient Protection and Affordable Care Act mandates incentive payments to hospitals that meet quality performance standards, which remain unspecified.
In 2008, the Massachusetts Health Care Quality and Cost Council
1
directed the Division of Health Care Finance and Policy (DHCFP) to study various approaches to estimating hospital-wide mortality rates as performance metrics. Medicare released hospital-wide mortality rates for its beneficiaries beginning in 1986 but suspended publication of the rates in 1993 because of methodologic concerns.
2
,
3
The United Kingdom, various European countries, and Canada . . .
Journal Article
Eliminating Health And Health Care Disparities Among The Growing Population Of People With Disabilities
Fifty-four million people in the United States are now living with disabilities. That number will grow substantially in the next thirty years, as the \"baby-boom\" generation ages and many of today's children and young adults mature and experience complications related to overweight and obesity. This reality poses a major challenge to the health care and policy communities. People with disabilities confront disadvantages from social and environmental determinants of health, including lower educational levels, lower incomes, and higher unemployment, than people without disabilities. Those with disabilities are also much more likely to report being in fair or poor health; to use tobacco; to forgo physical activity; and to be overweight or obese. People with disabilities also experience health care disparities, such as lower rates of screening and more difficulty accessing services, compared to people without disabilities. Eliminating these multifaceted disadvantages among people with disabilities should be a critical national priority. Adapted from the source document.
Journal Article
When Walking Fails
Roughly one in ten adult Americans find their walking slowed by progressive chronic conditions like arthritis, back problems, heart and lung diseases, and diabetes. In this passionate and deeply informed book, Lisa I. Iezzoni describes the personal experiences of and societal responses to adults whose mobility makes it difficult for them to live as they wish—partly because of physical and emotional conditions and partly because of persisting societal and environmental barriers. Basing her conclusions on personal experience, a wealth of survey data, and extensive interviews with dozens of people from a wide social spectrum, Iezzoni explains who has mobility problems and why; how mobility difficulties affect people's physical comfort, attitudes, daily activities, and relationships with family and friends throughout their communities; strategies for improving mobility; and how the health care system addresses mobility difficulties, providing and financing services and assistive technologies. Iezzoni claims that, although strategies exist to improve mobility, many people do not know where to turn for advice. She addresses the need to inform policymakers about areas where changes will better accommodate people with difficulty walking. This straightforward and engaging narrative clearly demonstrates that improving people's ability to move freely and independently will enhance overall health and quality of life, not only for these persons, but also for society as a whole.
eBook
'I Am Not The Doctor For You': Physicians' Attitudes About Caring For People With Disabilities
People with disabilities face barriers when attempting to gain access to health care settings. Using qualitative analysis of three physician focus groups, we identified physical, communication, knowledge, structural, and attitudinal barriers to care for people with disabilities. Physicians reported feeling overwhelmed by the demands of practicing medicine in general and the requirements of the Americans with Disabilities Act of 1990 specifically; in particular, they felt that they were inadequately reimbursed for accommodations. Some physicians reported that because of these concerns, they attempted to discharge people with disabilities from their practices. Increasing health care access for people with disabilities will require increasing the accessibility of space and the availability of proper equipment, improving the education of clinicians about the care of people with disabilities, and removing structural barriers in the health care delivery system. Our findings also suggest that physicians bias and general reluctance to care for people with disabilities play a role in perpetuating the health care disparities they experience.
Journal Article
Dangers of Diagnostic Overshadowing
Though Michael’s primary progressive multiple sclerosis was diagnosed when he was 42 and forced him to retire at 50, he continued to live a rich life. But like many patients with disability, when he began having worrisome new symptoms, he received substandard care.
Journal Article
Tailored vs. General COVID-19 prevention for adults with mental disabilities residing in group homes: a randomized controlled effectiveness-implementation trial
Background
People with serious mental illness (SMI) and people with intellectual disabilities/developmental disabilities (ID/DD) are at higher risk for COVID-19 and more severe outcomes. We compare a tailored versus general best practice COVID-19 prevention program in group homes (GHs) for people with SMI or ID/DD in Massachusetts (MA).
Methods
A hybrid effectiveness-implementation cluster randomized control trial compared a four-component implementation strategy (
Tailored Best Practices
: TBP) to dissemination of standard prevention guidelines (
General Best-Practices
: GBP) in GHs across six MA behavioral health agencies. GBP consisted of standard best practices for preventing COVID-19. TBP included GBP plus four components including: (1) trusted-messenger peer testimonials on benefits of vaccination; (2) motivational interviewing; (3) interactive education on preventive practices; and (4) fidelity feedback dashboards for GHs. Primary implementation outcomes were full COVID-19 vaccination rates (baseline: 1/1/2021–3/31/2021) and fidelity scores (baseline: 5/1/21–7/30/21), at 3-month intervals to 15-month follow-up until October 2022. The primary effectiveness outcome was COVID-19 infection (baseline: 1/1/2021–3/31/2021), measured every 3 months to 15-month follow-up. Cumulative incidence of vaccinations were estimated using Kaplan-Meier curves. Cox frailty models evaluate differences in vaccination uptake and secondary outcomes. Linear mixed models (LMMs) and Poisson generalized linear mixed models (GLMMs) were used to evaluate differences in fidelity scores and incidence of COVID-19 infections.
Results
GHs (
n
=415) were randomized to TBP (
n
=208) and GBP (
n
=207) including 3,836 residents (1,041 ID/DD; 2,795 SMI) and 5,538 staff. No differences were found in fidelity scores or COVID-19 incidence rates between TBP and GBP, however TBP had greater acceptability, appropriateness, and feasibility. No overall differences in vaccination rates were found between TBP and GBP. However, among unvaccinated group home residents with mental disabilities, non-White residents achieved full vaccination status at double the rate for TBP (28.6%) compared to GBP (14.4%) at 15 months. Additionally, the impact of TBP on vaccine uptake was over two-times greater for non-White residents compared to non-Hispanic White residents (ratio of HR for TBP between non-White and non-Hispanic White: 2.28,
p
= 0.03).
Conclusion
Tailored COVID-19 prevention strategies are beneficial as a feasible and acceptable implementation strategy with the potential to reduce disparities in vaccine acceptance among the subgroup of non-White individuals with mental disabilities.
Trial registration
ClinicalTrials.gov, NCT04726371, 27/01/2021.
https://clinicaltrials.gov/study/NCT04726371
.
Journal Article