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February 11, 2003

Increasing Access to Care Could Reverse Disparities

Providing frail elderly African Americans with comprehensive health care may
improve their health status and decrease mortality rates to levels in line with
those of their white counterparts, according to a study by researchers at the
San Francisco VA Medical Center (SFVAMC).

"It may never be too late to improve health outcomes by increasing people's
access to care," said Erwin Tan, MD, UCSF assistant clinical professor of
medicine. Tan conducted this study while a clinical researcher at the SFVAMC.
He currently practices at SF General Hospital Medical Center.

Numerous studies have described the health disparities between African
Americans and whites, showing that African Americans receive less health care
and are more likely to die from the same illness than their white
counterparts. This study is unique in that it describes a setting in which these disparities are reversed, allowing African Americans to live longer, healthier lives.

The current study appears in the February issue of the Journal of the American
Geriatric Society.

Tan and his colleagues found that providing integrated medical and health care
services actually allowed African American patients to fare better than whites
over time. The researchers compared health status and survival rates of
elderly African American and white participants enrolled at 12 nationwide sites of the Program of All-Inclusive Care for the Elderly (PACE) between 1990 and 1996. A total of 859 African American patients and 2002 white patients were
included in the study.

Upon enrolling in PACE, African American patients were younger and more
disabled by their illnesses than white patients, scoring significantly
lower on measures of mental health, ability to perform routine tasks and degree of
dementia. African Americans were, however, more likely to improve in health
status than whites after their first year. After a year of enrollment in PACE,
African American patients had a survival rate of 88 percent, slightly higher
than the 86 percent for white patients. After five years, survival rates were
51 percent and 42 percent, respectively.

"These are all patients who are sick enough and disabled enough to live in
nursing homes. PACE gives these people the services they need to continue to
live at home. In our study, African American patients enrolled in PACE
programs did better than we expected," Tan said.

PACE is a model of care created in the 1971 in San Francisco's Chinatown by On
Lok Senior Health. It was approved for Medicare reimbursement in 1997 and,
since then, more than 70 organizations in 30 states have established programs
based on the PACE model.

Tan attributes the success of PACE to its comprehensive, team approach. Each
PACE team consists of a range of providers; including primary care physicians,
dentists, dieticians, podiatrists, nurses and physical therapists. Even the
drivers who provide patients with transportation to their medical appointments
are included in the team's meetings held two to four times a year to discuss a
patient's progress.

Tan said he hopes the results of this study encourage more communities to
adopt the PACE model. "PACE is a national program that has already been successfully exported to other cities," Tan said.

Tan also said more research is needed to identify other ways of reversing
racial disparities in health outcomes and prevent these disparities from
developing in the first place. But, the current study offers hope to both
health care providers and an increasingly diverse elderly population that
continues to grow. "It's possible that giving people of all ages good
access to care will reverse the health disparities we see. But there may be other
reasons behind these disparities. We need to do more research to know for sure," Tan said.

Source:  Camille Mojica Rey


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