# Racial and Ethnic Disparities in Chronic Disease Outcomes and Nurse Practitioner Practice

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $569,939

## Abstract

Racial and ethnic health disparities among elderly patients with chronic conditions is a major challenge
affecting our health care system. Many chronically ill minority elderly lack high quality care, have poor health
outcomes, and often use emergency departments (EDs) and/or hospitals for routine primary care services. To
prevent the unnecessary use of costly health care services and assure minorities achieve best outcomes,
attention should be focused on clinics where these patients receive primary care, while taking into account
their individual and community characteristics. Nurse practitioners (NPs) disproportionality deliver primary care
to minorities and practice in underserved areas. Yet, to date, limited research has focused on the role of NPs
and practices employing NPs in reducing health disparities, and little is known about the characteristics of NP
practices where minorities receive care and whether the underlying differences in their organizational and
structural attributes are barriers to achieving reductions in health disparities. The overarching aim of this study
is to understand ways to reduce racial and ethnic disparities in outcomes of chronically ill elderly patients
receiving care from practices employing NPs. Our study will take a comprehensive integrated approach to
account for patient, community, practice, and state factors as a system determining disparities. Using multilevel
and geographic information system methods, we will achieve three specific aims: Aim 1. Assess the extent to
which racial and ethnic disparities in outcomes of chronically ill elderly patients are explained by differences
between or within primary care practices employing NPs. Aim 2. Determine the effect of a) NP clinical role, b)
care environments, and c) structural capabilities of primary care practices employing NPs on racial and ethnic
disparities in chronic condition outcomes for elderly patients. Aim 3. Assess the extent to which patients'
community characteristics (i.e., socioeconomic position and primary care availability) are related to racial and
ethnic disparities in patient outcomes. We will survey NPs and practice managers in 6 states with variable
scope of practice laws governing NPs to collect data about structural and organizational features of practices
employing NPs and link these measures to community data on socioeconomic factors and Medicare claims
data on hospitalization and ED visits. Our multilevel modeling approach will untangle the interrelated effects of
the NP role, care environments, structural capabilities, and community factors on disparities in outcomes of
elderly patients to point interventions to eliminate health disparities and identify practices and communities that
can most benefit from them. If differences in organizational and structural attributes of NP practices are found
to be associated with disparities, interventions could be targeted to practices serving minorities. Thus our
findings will inform administra...

## Key facts

- **NIH application ID:** 9844976
- **Project number:** 5R01MD011514-04
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Lusine Poghosyan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $569,939
- **Award type:** 5
- **Project period:** 2017-06-13 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9844976

## Citation

> US National Institutes of Health, RePORTER application 9844976, Racial and Ethnic Disparities in Chronic Disease Outcomes and Nurse Practitioner Practice (5R01MD011514-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9844976. Licensed CC0.

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