UNDERSTANDING AND REDUCING ETHNIC DISPARITIES IN PREVENTABLE HOSPITALIZATIONS

University Of Hawaii At Manoa, Honolulu HI

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Abstract

Native Hawaiians and other Pacific Islanders (NHOPI) suffer disproportionately from cardiometabolic disorders, including cardiovascular disease and diabetes. Hospitalizations comprise the largest percentage of health care costs for both cardiovascular disease (CVD) and diabetes (DM), yet little research including NHOPI identifies or addresses preventable hospitalizations (PH) or preventable re-hospitalizations (PreH) for CVD or DM. Understanding and reducing these hospitalizations is an important focus for improving health equity for NHOPI. Preventable hospitalizations represent not only unnecessary spending, but also unnecessary suffering and strain on individuals and families. There is reason to believe large disparities exist. Many NHOPI lack access to effective chronic disease management and/or culturally appropriate care. Dramatic PH and PreH disparities have been seen in other minority racial/ethnic groups compared to Whites. This study will fill key gaps in the literature about: (1) the prevalence and cost burden of PH and PreH among NHOPI, (2) the factors that drive PH and PreH in NHOPI; and (3) effective interventions to reduce PH and Pre-H in NHOPI. Specifically this project will: (1) Identify disparities in prevalence and cost of PH and PreH for CVD or DM in NHOPI compared to Whites across 10-years, (2) Conduct a prospective, mixed-methods study of patients admitted with a PH and PreH for CVD or DM over a 2-year period at a large, safety-net hospital to examine the factors contributing to disparities; and (3) Design and pilot a hospital-based intervention to decrease disparities in PreH for CVD and/or DM targeting key factors identified in Aims 1 and 2. Our multi-faceted approach will provide important new data and detailed insight into a complex phenomenon with direct health implications and notable policy and clinical relevance. Findings will be relevant to diverse efforts by multiple stakeholders to improve the health equity of NHOPI, and will provide novel insight for research and clinical efforts to reduce and understand PH and PreH in other vulnerable racial/ethnic groups.