The EXPORT Center of Excellence

In conjunction with the University of Puerto Rico and Harvard Medical School, the Disparities Research Unit is part of a multi-site continuation of the EXPORT Center.

Through partnership with the University of Puerto Rico and Harvard Medical School, the Disparities Research Unit at Massachusetts General Hospital is part of a multi-site continuation of the Excellence In Partnerships For Community Outreach, Research on Health Disparities and Training (EXPORT) Center, funded through the National Center on Minority Health and Health Disparities. This Comprehensive Research EXPORT Center of Excellence focuses on understanding the multiple and complex factors contributing to mental health disorders, substance use disorders, and pediatric asthma disparities among mainland and island Latino populations. The overall goal of the Research Center of Excellence is to conduct research on Latino health and health care disparities to generate and test models of improved service delivery to eliminate these disparities.

Aims

• Aim 1: Establish an administrative structure that integrates and centralizes a synergistic core of researchers into a single interdisciplinary and trans-disciplinary research enterprise by pulling together resources, leadership, and expertise from the mainland United States and the island of Puerto Rico to conduct asthma and mental disorders disparities research in Latino communities
• Aim 2: Continue to establish, strengthen and maintain partnerships with organizations and communities for conducting original and relevant research leading to improvement in Latino health and in eliminating service disparities
• Aim 3: Enhance the research and training activities of the ongoing EXPORT Center to mentor and develop Latino investigators and to increase the number of minority researchers who conduct scientifically rigorous Latino health and health disparities research
• Aim 4: Formulate and conduct an interdisciplinary asthma and mental health services and intervention research program to increase our understanding of and eliminate and/or reduce service disparities of Latinos in all stages of their life cycle (children, adults and the elderly)
• Aim 5: Disseminate and integrate the product of these efforts to inform policy decisions, clinical practice and community partners, and orient the health service systems to provide culturally and linguistically appropriate services

Projects and Pilots

Pediatric Asthma Community Based Program: Eliminating Asthma Disparities (PACBP)

This project proposes to test the effectiveness of a multi-level asthma management program geared to eliminate asthma disparities in treatment by intervening at the family, provider and health policy level. The effectiveness of PACBP in reducing asthma morbidity and service utilization as well as costs, will be tested in a randomized control trial in a pilot health region of the island.

The Right Question Project - Mental Health

The Right Question Project – Mental Health project is a randomized control trial designed to test and evaluate a patient activation and self-management intervention in mental health care, and identify whether provider training can further increase patient activation and self-management in the clinical encounter. The main objective of the patient activation and self-management trainings is to help patients learn how to formulate and ask questions about mental health care concerns and treatment; to focus and participate effectively on key decisions made during the course of mental health treatment; and to better self-manage their illness and mental health care.

This RO1 is the expansion of the Right Question Project pilot, conducted as part of the first EXPORT grant. Pilot results showed that as patients practice strategies for obtaining information from providers, they become active participants in care and clarify expectations of treatment, thereby increasing patient-provider dialogue that allows for greater patient involvement and decision-making. The pilot study illustrated the promise of a simple and relatively low-cost intervention that is appropriate for low literacy populations.

By conducting this patient intervention on a larger scale and pilot-testing a provider intervention component, we hope to provide evidence for an intervention that might improve patient engagement and retention in mental health care.

Project Aims:

• Aim 1: Conduct a randomized controlled trial to test a patient activation and self-management intervention for Latino and non-Latino white mental health patients, and assess the impact of the intervention on the following outcomes: perceived self-management, perceived activation, and engagement and retention in mental health care.
• Aim 2: Investigate the relative effectiveness of adding a provider training component designed to increase receptivity to patient activation and self-management, using a quasi-experimental design.

Disparities in Substance Abuse Treatment

We are conducting four sets of analyses aimed at better understanding the magnitude of substance abuse treatment disparities, the mechanisms by which they occur, and the social and economic burden of these disparities. These analyses are designed to generate policy-relevant information that will impact a wide range of key stakeholders in the health disparities and substance abuse field, including academics, practitioners, community leaders and the general public.

This R01 aims to provide a comprehensive picture of the extent of substance disorder treatment disparities, the potential sources of intervention to remediate these disparities, and the social and economic burden associated with substance use disorders in minority populations. We intend to use the results of the study to supply service planners, policymakers, and service administrators with the best available data on the magnitude and sources of racial/ethnic disparities in alcohol and drug abuse treatment services, and information about the consequences of substance use disorders in ethnic and racial minority populations in the United States.

Project Aims:

• Aim 1: Estimate and compare the level of unmet need for substance abuse treatment services by racial/ethnic group: Asians, Latinos, African Americans, and non-Latino whites.
• Aim 2: Estimate the level of disparities between each racial/ethnic minority group (Asians, Latinos, and African Americans) and non-Latino whites in utilization of substance abuse treatment.
• Aim 3: Preliminary work conducted for Aim 2 assists in the completion of Aim 3 as we will be using the same estimation models to identify mechanisms of disparities in substance abuse and alcohol treatment.

Disparities in Mental Health Care in Nursing Homes

This pilot documents disparities in the treatment and outcomes of mentally ill nursing home residents exist by race and ethnicity and decomposes the sources of any disparities in the treatment and outcomes of mentally ill nursing home residents and determine whether they are predominantly a “within” or “across” facility phenomenon.

The Training Institute

Under the P60 EXPORT grant, the University of Puerto Rico and Harvard Medical School have collaborated in a mentoring process for junior investigators. The main goal is to establish an administrative structure that integrates and centralizes a synergistic core of researchers into a single interdisciplinary and trans-disciplinary research enterprise by pulling together resources, leadership, and expertise from the mainland United States and the island of Puerto Rico to conduct asthma and mental health disparities research in Latino communities.

Investigators

Disparities Research Unit – Massachusetts General Hospital

Margarita Alegria, Ph.D. – Co-Principal Investigator
Sheri Lapatin Markle, MIA – Investigator

University of Puerto Rico – Behavioral Sciences Research Institute

Glorisa Canino, Ph.D. – Co-Principal Investigator

Department of Health Care Policy – Harvard Medical School

Thomas McGuire, Ph.D. – Training Core Director