Diana Romero, PhD* Presentation at: APHA meeting, 11/5/07 Case Management Outcomes Among HIV/AIDS Patients: A Case of the Latino Paradox? Diana Romero, PhD* Presentation at: APHA meeting, 11/5/07 *Urban Public Health Program, Hunter College, City University of New York

Acknowledgements Co-investigators: Funding: Gina Osorio, MD Mailman School of Public Health, NY Catherine Correa Bergen-Passaic EMA, Paterson, NJ Jesse Thomas RDE Systems, NJ Funding: Columbia Center for the Health of Urban Minorities (CHUM), NCMHD

Study Background Collaboration: academic institution and public health agency Ryan White Bergen-Passaic (NJ) EMA Use/testing of web-based administrative data system for health services research (eCOMPAS)

Passaic and Bergen Counties: 2000 Socioeconomic Indicators Northern NJ/Greater NY Metropolitan Area Passaic Median income: $49K Poverty (indiv): 12% Bergen Median income: $65K Poverty (indiv): 5%

Research Objective and Question Determine the potential utility of a web-based administrative data set for assessing factors related to health outcomes Recommendations to improve data collection and technological functions Question Which demographic, social, economic, and/or health-related variables are associated with the 4 outcomes of interest?

Methodology Imported eCOMPAS data into SPSS statistical software Selected Case Management dataset for analysis (n=3,805) Identified 4 key outcomes for analysis Conducted bivariate analyses and entered significant variables into the multivariate models

Outcome and Predictor Variables Outcomes Patient Skills Scale Adherence to HIV regimen Kept 3 of 4 medical appointments Kept 3 of 4 case mgmt appointments Predictor Variables Demographic/Social Gender, Race, Age County of residence Housing Living situation Economic Source of income Employed, Insurance Health-related HIV status Caregiver support Advantages and Disadvantages of Open and Closed Q’s  OPEN: ADV: Permits R to answer in her own words, on own terms, understand topic of interest as seen by respondent Often can get what is most important to R; unbiased by assumptions of researcher (except in the Q's asked!!) Allows disc. of context, meaning, things not easily operationalized into precoded categories.   DISADV OF OPEN: Time, both during interview and to code responses Answer R gives may be irrelevant to your question/problem/issue (Difficult for inexperienced interviewers) CLOSED, ADV. By "forcing' R to answer in a particular manner, have standard, comparable data across groups Attn to YOUR research question (+ data easily quantified) CLOSED DISADV: (SEE ADV. OF open): - we might omit an answer category that is very important to R and never know it (interviewer bias; also leave out what's most imp. to R) - Kalamazoo study example (open gets at feelings that can't easily precode; supports closed Qs)

Framework

Outcome 1: Patient Skills Scale “Lower patient skill level” associated with: AIDS status No other source of income Unemployed/not in labor force White, non-Hispanic Passaic county of residence No private health insurance

Outcome 2: Adherence to HIV regimen “Lower adherence” associated with: AIDS status Male gender Receipt of welfare No other source of income White, non-Hispanic Bergen county of residence No private health insurance

Outcome 3: Kept 3 of 4 Medical Appointments “Didn’t keep medical appointments” associated with: AIDS status Receipt of welfare White, non-Hispanic

Outcome 4: Kept 3 of 4 Case Mgmt Appointments “Didn’t keep case mgmt appointments” associated with: Receipt of welfare No other source of income Unemployed White, non-Hispanic Bergen county of residence “Don’t Know” about receipt of care-giver support

Summary: Multivariate Findings Adherence Patient Skills Medical Appt Case Mgmt Appt DEMOGRAPHICS Gender  (M) Age Race/ethnicity  (B,W)  (W,H)  (W,B) County of residence  (B)  (P) SOCIAL Unemployed  Able to work Social Support Housing ECONOMIC Income from work Welfare No other income HEALTH-RELATED HIV status (AIDS) Caregiver Support Medicaid Medicare No private insurance

Discussion: Paradoxical” Findings Race/ethnicity Latino Paradox White disadvantage? County of residence Better outcomes in less affluent pop’n More services? Welfare Can welfare receipt lead to “equity”?