Grant Awarded to Houston VA to Study Behaviors, Treatment Selection of Patients with Coronary Disease

Researchers at the Houston Veterans Affairs Center for Quality of Care & Utilization Studies have received a $400,000 grant to examine the health-seeking behaviors and treatment selection of patients with coronary disease.

The local study, scheduled to begin in September, will include African American, Hispanic and white patients from the Houston VA Medical Center.

"We know that treatments such as cardiac catheterization and coronary bypass graft surgery are well established, but the use of these procedures is lower in blacks and Hispanics when compared to whites," says Dr. Howard S. Gordon, principal investigator and VA Research Career Development Awardee. "There are many factors involved, but reasons for the disparities remain in dispute."

In prior studies, researchers have asserted a strong link between the disparity in treatment or utilization of services and variables such as severity of coronary disease, socioeconomic status, and access to care. However, says Dr. Gordon, most of these prior studies have been unable to explain these disparities, even when using detailed data about demographics and patients' medical conditions.

"Of further importance," says Dr. Gordon, "most of the prior studies have failed to consider variations in patients' willingness to undergo diagnostic or therapeutic procedures recommended by their physicians based on [patients'] ethnic beliefs. Instead, the few studies examining this have relied on descriptions based on what investigators believe are questions that are important to ask."

Dr. Gordon and co-principal investigator Dr. Debora A. Paterniti, a qualitative sociologist, suggest a different approach to understanding patients' health seeking behaviors and treatment selection - one that includes patients' direct experiences.

Drs. Gordon and Paterniti will enroll about 160 patients and form 10 focus groups for the study. "Focus groups are one of the best strategies for uncovering patient beliefs," says Dr. Paterniti. "Our focus group is designed to assess all possible reasons why patients make their decisions. We are going to ask patients what their perceptions are, what made them seek health care, and what factors are important to their decisions about treatment.

"We suspect that social networks impact the way people perceive their potential outcome and guide their decision making. For example, people with a family history of heart disease and coronary bypass treatment may gauge or base their decisions based on the outcomes of their family members," she says.

After interviewing patients and analyzing their responses, the researchers will use the research data to develop a checklist survey, an instrument to measure and rank the important decisions which patients often face.

"The determinants instrument will be used to assess which items are prevalent and their relative importance to patients' decisions to undergo invasive testing or treatment. We will be able to rank how important each item is for the respondent," says Dr. Gordon. The goal, he says, is to provide new insight for both patients and doctors. "I really hope that this research will offer new insight to understanding which factors are most important to patients' decisions and will help doctors improve their ability to provide the highest quality medical care," he says.

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