Center for Health Equity Research and Promotion
CHERP Research and Accomplishments
Leslie Hausmann, PhD pilot-tested uses techniques adapted from the field of positive psychology to reduce arthritis-related pain and racial disparities in pain that may be due, in part, to psychosocial stressors such as perceived discrimination.
Testing Interventions to Reduce Health Disparities
Many patients served by the VA Healthcare System belong to racial and socioeconomic groups that are at increased risk of experiencing or perceiving acts of discrimination, which is a known risk factor for poor health behaviors and outcomes. Leslie Hausmann, PhD and colleagues are now taking steps towards mitigating the impact of discrimination on health and alleviating health disparities among Veterans.
In her recently completed VA HSR&D Career Development Award research, Dr. Hausmann demonstrated that discrimination perceived by patients within the health care system is associated with negative outcomes such as less positive patient-provider communication, lower trust in physicians, poorer health outcomes, and less utilization of some preventive healthcare services.
“We studied these issues in patients with a variety of conditions, including osteoarthritis, diabetes, heart disease, and hypertension,” says Dr. Hausmann, Core Investigator with the VA Center for Health Equity Research and Promotion (CHERP). “Our results informed the development of interventions to reduce the negative effects of perceived discrimination in the health care setting.”
One intervention that Dr. Hausmann pilot-tested uses techniques adapted from the field of positive psychology to reduce arthritis-related pain and racial disparities in pain that may be due, in part, to psychosocial stressors such as perceived discrimination. Currently available arthritis treatments yield only small to moderate improvements in pain and are not effective at reducing racial disparities in pain. Evidence from the field of positive psychology suggests that interventions designed to develop a positive mindset have the potential to improve pain and functioning and reduce racial disparities in patients with arthritis, a condition that disproportionately affects African Americans. Although proven techniques for developing a positive mindset have been tailored for use in patient populations with a variety of clinical conditions, they have not been tested in patients with arthritis or in Veterans.
Dr. Hausmann’s team pilot-tested a structured program of activities designed to help Veterans develop a positive mindset over the course of 6 weeks. Results of a pilot study indicated that the program was successful in improving pain and function in Veterans with arthritis. A multi-site randomized controlled trial of the program in larger sample of Veterans with arthritis will begin this fall.
Click here to read the VA Currents feature story about Dr. Hausmann’s work in “Pain reduction, via positive psychology and the Web.”
Related Health Equity Initiatives
• Dr. Hausmann partnered with the VHA Office of Health Equity (OHE) on a quality improvement project to develop and evaluate a novel Patient Aligned Care Team (PACT)-centered cultural competency training program about unconscious bias. OHE plans to use the findings of the report, due out later this summer, to advise on future implementation of the program across VHA.
• Given the negative impact of perceived discrimination on patient health care experiences, Dr. Hausmann partnered with the VHA Office of Analytics and Business Informatics to examine racial, ethnic, and gender differences in outpatient and inpatient health care experiences using the VHA Survey of Healthcare Experiences of Patients (SHEP). She is also collaborating on a related HSR&D-funded mixed-methods study, led by CHERP investigator Susan Zickmund, PhD, that will identify modifiable sources of racial and ethnic disparities in satisfaction with VA care among men and women Veterans.
• Dr. Hausmann is currently working with VISN4, VHA OHE, and CHERP investigators on a quality improvement initiative to reduce racial disparities in blood pressure management throughout VISN4. In 2013, VISN4 partnered with CHERP to create a Health Equity Dashboard, which provides information on 19 VA quality performance measures stratified by patient race (i.e., black and white) and gender for all 10 VA Medical Centers in VISN4. Dr. Hausmann is leading an evaluation of the roll-out and impact of the Health Equity Dashboard within VISN4 to inform future system-wide efforts to reduce racial disparities in blood pressure control and other health outcomes across VHA facilities.
• Beginning in October of 2014, Dr. Hausmann will work with the VISN4 Center for Evaluation of PACT (CEPACT) to improve patient-centered care and reduce racial disparities in patient-centered care by disseminating best practices within VISN4 and building tools to disseminate best practices nationwide.
