National initiatives in the United States call for health research that addresses racial/ethnic disparities. Although grounded theory (GT) research has the potential to contribute much to the understanding of the health experiences of people of color, the extent to which it has contributed to health disparities research is unclear. In this article we describe a project in which we reviewed 44 GT studies published in Qualitative Health Research within the last five years. Using a framework proposed by Green, Creswell, Shope, and Clark (2007), we categorized the studies at one of four levels based on the status and significance afforded racial/ethnic diversity. Our results indicate that racial/ethnic diversity played a primary role in five studies, a complementary role in one study, a peripheral role in five studies, and an absent role in 33 studies. We suggest that GT research could contribute more to health disparities research if techniques were developed to better analyze the influence of race/ethnicity on health-related phenomena.
From Hospital to Home and Back Again: A Study in Hospital Admissions and Deaths for Home Care Patients10/01/2005
In this study, the authors examined causes of deaths or hospitalizations of adult home care patients during an 18-month period using a retrospective medical record audit. The site of the study was the home care program of a three-hospital system. Of 4,303 cases, 101 adult patients met study criteria of hospitalization or death. The death rate in the sample was 0.48%, and the hospitalization rate was 1.9%. Wound deterioration and falling accidents were principal causes for rehospitalizing patients. Increasing age and number of medications were significantly correlated with falls resulting in hospitalization. Patients who died were found to suffer from terminal illnesses and frailty, with care providers having little influence over outcomes. Opportunities to improve clinical care processes (e.g., discharge planning, patient status monitoring, signs and symptoms reporting, interdisciplinary communicating and coordinating) were also identified. The authors concluded that nearly 21% of hospitalizations were potentially preventable.
The prevalence of metabolic syndrome in cardiac rehabilitation (CR) makes CR an ideal place to offer interventions to address metabolic syndrome–related risk. There is a lack of research related to the metabolic syndrome practices in CR. Therefore, the purpose of this research was to describe practices to assess CR patients for metabolic syndrome, interventions specific to metabolic syndrome, and staff knowledge and beliefs related to metabolic syndrome.
This was a cross-sectional study of CR providers in Ohio (n = 94). Program practices and interventions and staff knowledge and beliefs were assessed and stratified on the program use of case management, program certification by the American Association of Cardiovascular and Pulmonary Rehabilitation, and staff profession.
At CR entry, 26% of the programs assessed patients for the metabolic syndrome and 8% had written guidelines for metabolic syndrome. Less than half of the staff (47%) was able to name 3 or more risk factors for metabolic syndrome. Programs using case management were more likely to identify metabolic syndrome (P < .001), measure waist circumference (P < .001), order a new lipid profile (P = .04) at program entry, and have written guidelines for managing metabolic syndrome (P = .01) than programs not using case management. No differences were observed in stratified analyses for the program certification or staff profession.
The majority of CR programs do not assess patients for metabolic syndrome or have written guidelines for the metabolic syndrome. Opportunities exist for better management of metabolic syndrome in CR.