This thesis identifies and analyzes the legal barriers faced by ethno-racial psychiatric consumer/survivors in Ontario, through an analysis of the Consent and Capacity Board (CCB). I employ interdisciplinary research to test the hypothesis that factors such as race, ethnicity, culture, poverty and social exclusion are not fully addressed by the CCB. To critique the CCB, I developed a theoretical framework using the grounded theory approach, in combination with tenets of disability theory, critical race theory and intersectionality. I used the theoretical framework to analyze qualitative research involving twenty interviews of stakeholders including lawyers, psychiatrists, CCB adjudicators, mental health service providers and ethno-racial psychiatric consumer/survivors. The analysis revealed the procedural, systemic/structural and discretionary barriers within the CCB’s pre-hearing, hearing and post-hearing process. Barriers were the result of cultural misunderstandings, misdiagnosis, complex familial relationships, culturally inappropriate care, institutional racism, poverty, discrimination and the CCB’s “color blind approach.” I conclude with prioritized recommendations.

This thesis identifies and analyzes the legal barriers faced by ethno-racial psychiatric consumer/survivors in Ontario, through an analysis of the Consent and Capacity Board (CCB). I employ interdisciplinary research to test the hypothesis that factors such as race, ethnicity, culture, poverty and social exclusion are not fully addressed by the CCB. To critique the CCB, I developed a theoretical framework using the grounded theory approach, in combination with tenets of disability theory, critical race theory and intersectionality. I used the theoretical framework to analyze qualitative research involving twenty interviews of stakeholders including lawyers, psychiatrists, CCB adjudicators, mental health service providers and ethno-racial psychiatric consumer/survivors. The analysis revealed the procedural, systemic/structural and discretionary barriers within the CCB’s pre-hearing, hearing and post-hearing process. Barriers were the result of cultural misunderstandings, misdiagnosis, complex familial relationships, culturally inappropriate care, institutional racism, poverty, discrimination and the CCB’s “color blind approach.” I conclude with prioritized recommendations.

Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Many areas of clinical informatics research rely on accurate and complete race and ethnicity (RE) patient information, such as estimating disease risk, assessing quality and performance metrics, and identifying health disparities. Structured data in the electronic health record (EHR) is an easily accessible source for patient-level information, however RE information is often missing or inaccurate in structured EHR data. Furthermore, current federal standards on RE categories have been acknowledged as inadequate, and in need of more granular realizations. While more difficult to extract data from, clinical notes provide a rich, nuanced and subjective source of information that can be leveraged to increase granularity and/or recover RE information missing in structured data. State-of-the-art clinical natural language processing (NLP) approaches can enable researchers to extract RE information from clinical notes, however, NLP has also been shown to inherit, exacerbate, and create new biased and harmful associations, especially in modern deep learning approaches. This thesis explores the relationships between direct and indirect explicit mentions of RE and RE inferences in clinical text annotated by humans, and leverages an approach to audit deep NLP models for their learned associations. We develop gold-standard annotations for information related to RE (RE indicators) and RE labels. We leverage four RE indicators: country of origin, spoken language, direct race, and direct ethnicity mention. We find high agreement between annotators for RE label assignments, and that sentences assigned RE categories have drastically different distributions of RE indicators. Furthermore, we find high agreement between structured and unstructured sources of RE information, and that unstructured data can be used to recover missing RE information in structured data. Leveraging the gold-standard RE annotations, we train a model to label sentences with RE information and audit the model to examine the alignment between salient features and RE indicators. While our models attain good classification performance, this does not translate into high overlap with RE indicators. We find evidence for learned associations that are benign mistakes, helpful but not strictly correct, and potentially harmful mistakes if not addressed by future work.

This dissertation aims to examine racial and ethnic inequities in nursing home (NH) palliative care services and potentially avoidable hospitalizations at the end of life. Health disparities are pervasive in NHs, but disparities in NH end-of-life care (i.e. palliative care services, hospital transfers) have not been comprehensively examined. Chapter One provides an overview of this dissertation, which explores inequities in nursing home end-of-life care. Chapter Two is a systematic review that synthesized the current state of the science in racial and ethnic disparities in NH end-of-life care. Chapter Three was designed to describe palliative care services in U.S. NHs and associations with differences in the concentrations of Black and Hispanic residents, respectively, and the impact by region. Chapter Four is an analysis of racial and ethnic differences in NH potentially avoidable hospitalization incidence rates. Finally, Chapter Five is a synthesis of this body of work. It contains a summary of findings of this dissertation, a discussion of the results, practice and policy implications, and directions for future research.

Thesis (M.S.)--Oregon State University, 2008. / Includes bibliographical references (leaves 72-76).

Thesis (Ph.D.)--Pardee Rand Graduate School, 2007. / Title from title screen (viewed on June 13, 2008). Includes bibliographical references.

Thesis (M.S.)--University of North Carolina at Wilmington, 2005. / Includes bibliographical references (leaves: [25]-33)

Existing research on health disparities in breast cancer is heavily focused on outcomes for poor or low-income women. Little is known about the experience of privately insured Black breast cancer patients that have moderate to high SES. As a result, the present study was conducted to learn more about their experiences. It examines differences in physician prescribing of two breast cancer pain treatments, peripheral nerve block (PNB) and opioids, for Black and White women with like levels of health insurance coverage and socioeconomic status (SES). Three specific questions are addressed: 1. What, if any, race-based disparities exist in usage of PNBs at time of total mastectomy? 2. What, if any, race based disparities exist in the prescription of opioids for postoperative pain following total mastectomy? 3. What, if any, changes have occurred in the frequency of orders placed for PNBs and prescription opioids over time, to treat postoperative pain resulting from mastectomy? A cross-sectional designed was used relying on an existing national dataset, Optum Clinformatics Data Mart. The study period was January 1, 2012, through December 31, 2019. Study results revealed that while moderate to higher SES Black women have equitable access to PNB and opioids - a kind of shield from long established physician bias against Black women – this protection is quite porous. They still do not have open and ready access to PNB as a more advanced pain treatment. Nor do they have assurance that they are protected from the overprescribing of opioids, a class of drugs with serious and well-known safety risks. Therefore, on the surface, it appears that equity and racial inclusion are hallmarks of physician prescribing of postoperative breast cancer pain treatment. However, further interrogation reveals that ‘separate and somewhat equal’ is a more accurate characterization of their prescribing practices, based both on race and SES.

In 1869 the General Assembly of the Commonwealth of Virginia passed legislation that established the first asylum in the United States to care exclusively for African-American patients. Then known as Central Lunatic Asylum for the Colored Insane and located in Richmond, Virginia, the asylum began to admit patients in 1870. This thesis explores three aspects of Central State Hospital's history during the nineteenth century: attitudes physicians held toward their patients, the involuntary commitment of patients, and life inside the asylum. Chapter One explores the nineteenth-century belief held by southern white physicians, including those at Central State Hospital, that freed people were mentally, emotionally, and physically unfit for freedom. Chapter Two explains the involuntary commitment of African Americans to Central State Hospital in 1874. Chapter Three considers patient life at the asylum by contrasting the expectation of “Moral Management” care with the reality of daily life and treatment.