1. 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

2. 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

3. 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)

4. 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%

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?

6. 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

7. 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)

8. Framework

9. 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

10. 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

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

12. 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

13. 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

14. 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”?