# The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care.

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2024 · $475,276

## Abstract

Project Summary
High-quality care throughout the trajectory of illness of Alzheimer's disease and Alzheimer's disease-
related dementias (AD/ADRD) has been shown to be associated with a better quality of life, lower caregiver
distress, and reduced use of acute and long-term care. However, racial and ethnic (R&E) minoritized persons
with AD/ADRD often receive poorer quality care than White patients, including lower rates of advance
directives, reduced receipt of anti-dementia medications, and increased end-of-life hospitalizations. Although
governmental and institutional policies influence R&E diversity in medical education/training and work
environments, little is known about how R&E diversity in medical education, residency training, and health
system leadership affect R&E disparities in AD/ADRD care. This knowledge gap has hindered efforts to
develop interventions that could effectively eliminate disparities in AD/ADRD care. The proposed study will
address these important knowledge gaps by applying the quasi-experimental methods to the comprehensive
data on patients, physicians, medical schools, residency programs, and health systems we will develop by
linking 7 nationally-representative databases (Medicare Claims Data, Consumer Assessment of Healthcare
Providers and Systems Data, Doximity Physician Data, Association of American Medical Colleges Medical
School Data, American Medical Association Residency Program Data, RAND Health System Data, and
American Hospital Association National Health Care Governance Survey Data). In Aim 1, we will determine
the effect of the R&E diversity of medical school student bodies from which physicians graduated on disparities
in AD/ADRD care, by applying the quasi-experimental instrumental variable method using the state affirmative
action bans as an instrument. The state affirmative action bans serve as an ideal instrument because they are
strongly associated with medical school student body diversity, but do not directly affect AD/ADRD care. In
Aim 2, we will determine the effect of 4 residency program characteristics (higher R&E diversity of residents,
presence of cultural competence awareness program, instruction in medical Spanish or other non-English
languages, and rotation at the county and safety-net hospitals) on R&E disparity in AD/ADRD care, using the
propensity score matching method. In Aim 3, we will determine the effect of R&E diversity of health system
boards on disparities in AD/ADRD care, by applying the propensity score matching method. This project will
provide a robust evidence base for policymakers to develop policy interventions (e.g., increasing R&E diversity
and introducing the cultural competency awareness program at medical schools, residency programs, and
health systems) that could effectively mitigate R&E disparities in AD/ADRD care. The research team consists
of investigators with expertise in all relevant fields (Alzheimer's disease and dementia research, R&E disparity
research, med...

## Key facts

- **NIH application ID:** 10907033
- **Project number:** 5R01AG082991-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Yusuke Tsugawa
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $475,276
- **Award type:** 5
- **Project period:** 2023-08-15 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10907033

## Citation

> US National Institutes of Health, RePORTER application 10907033, The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care. (5R01AG082991-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10907033. Licensed CC0.

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