title: Examining healthcare disparities in a disease management population.
abstract: OBJECTIVE
  To examine whether racial disparities in healthcare exist in a heart failure population and to estimate the impact of disease management (DM) on any identified disparities.
  
  
  METHODS
  Before-after cohort study.
  
  
  METHODS
  A total of 2619 high-risk heart failure patients (2129 whites and 490 blacks) who participated in a DM program for at least 90 days between July 2001 and July 2003 were examined. Analysis was stratified by sex and age (< 65 years and > or = 65 years). Functional status as measured by the New York Heart Association (NYHA) classification system and mental and physical quality of life (QOL) as measured by the 8-Item Short-Form Health Survey were used to assess disparities between races.
  
  
  RESULTS
  At baseline, 33.7% of black versus 44.3% of white older women and 32.6% of black versus 48.5% of white older men were at NYHA level I or II (P < .01 and P = .005, respectively). At the most current measurement, the differences between the cohorts disappeared. Results were similar for the younger male, but not the younger female, cohort. The only QOL disparities at baseline were in favor of blacks. Both races had significant increases in mean mental and physical QOL scores (P < .001) after involvement in the DM program.
  
  
  CONCLUSIONS
  Disparities in QOL were not observed between blacks and whites at baseline or over the course of the study. Disparities in functional status at baseline disappeared over time, implying that DM may help reduce disparities and maintain equity in healthcare outcomes.
authors.affiliation: CorSolutions, Inc, 9500 West Bryn Mawr Ave, Suite 500, Rosemont, IL 60018, USA. dwalker@corsolutions.com
authors.forename: David R
authors.initials: DR
authors.lastname: Walker
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Stern
authors.forename: Darryl L
authors.initials: DL
authors.lastname: Landis
mesh_terms: D000368:Aged; D002303:Cardiac Output, Low / Q000208:ethnology / Q000628:therapy*; D015331:Cohort Studies; D019468:Disease Management; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D044469:Racial Groups; D012935:Social Justice; D014481:United States