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racial and ethnic disparities in health care 2018

But some experiences are common to many people within these groups, and social determinants of health … “This was an important piece of the collaborative,” says Christina Yongue, M.P.H., coordinator of the Greensboro Cancer Care and Racial Equity study. Of particular note is how the ACA has narrowed disparities in coverage rates between different racial and ethnic groups. By Martha Hostetter and Sarah Klein—Sept. Findings: Using National Health Interview Survey data from 1999-2018, we found that insurance coverage increased across all 4 major race/ethnicity groups. Executive Summary. The Greensboro Health Disparities Collaborative partnered with Cone Health’s Wesley Long Cancer Center and the University of Pittsburgh Medical Center’s Hillman Cancer Center in a project known as ACCURE (Accountability for Cancer Care Through Undoing Racism and Equity). This work may lead to customized interventions rather than standardized protocols. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. NCHS data on racial and ethnic disparities. Racial health disparities are a significant barrier to maintaining good health and quality of life for communities of color in the United States. But the studies suggest, for example, that we believe black women less when they express symptoms, and we tend to undervalue their pain.”. 2018 National Healthcare Quality and Disparities Report, https://www.ahrq.gov/research/findings/nhqrdr/nhqdr18/index.html, AHRQ Publishing and Communications Guidelines, Healthcare Cost and Utilization Project (HCUP), Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase, Funding Opportunities Announcement Guidance, AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Public Access to Federally Funded Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, Appendix A. “That was really important to us because it represents real morbidity, real mortality — people dying of strokes and heart attacks that could have been prevented if their blood pressure were controlled,” Wong says. Kaiser Permanente photo novella depicting Latino family members trying to convince their loved one to use FIT. Less directed efforts to improve health outcomes, ones for instance that fail to consider the particular factors that may lead to worse outcomes for blacks, Hispanics, or other patients of color, may not lead to equal gains across groups — and in some cases may exacerbate racial health disparities. Her goal was to create a custom model of support for women of color during their pregnancy, childbirth, and postpartum periods. 4 | 2018 National Healthcare Quality and Disparities Report. Specially trained ACCURE nurse navigators worked with patients to ensure they understood their treatment options and had financial and social supports. Between 2009 and 2017, Kaiser increased the percentage of African Americans whose hypertension was controlled from 75.3 percent to 89.6 percent, bringing the rate within 2.2 percentage points of the rate among white members. Ninety-two percent of women who received labor support attended their six-week postpartum appointment, and 89 percent were able to initiate breastfeeding (compared with 79 percent of women nationally). By the end of 2017, three months after this intervention began, an additional 757 more patients of color had been screened. The contribution of NICU care to disparities in outcomes is unclear. Ten years ago, Southern Jamaica Plain Health Center, a Boston primary care clinic associated with Brigham and Women’s Hospital, launched an effort to understand why there were such stark health inequities between white youth and youth of color in their neighborhood. These findings have led some health care researchers to suggest that the experience of being a black woman in America is, itself, a risk factor — and that attention must be paid both to black women’s level of stress throughout their lives and how they are treated by health care professionals. “Framing it as something that happened to other people might make others feel like they can speak up.” As word spread to patients and other staff about this pilot, they began requesting visits with doctors who were participating. Access to health insurance is often the first step in receiving quality, affordable health care. This issue of Transforming Care offers examples of health systems that are making efforts to identify implicit bias and structural racism in their organizations, and developing customized approaches to engaging and supporting patients to ameliorate their effects. Objectives To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. “We’re taught that racism is evil so it’s hard to recognize that in ourselves. Focus group research uncovered concerns among many minority patients about the invasiveness and inconvenience of the traditional colonoscopy. In 2017 there continued to be no statistically significant difference in the nonelderly uninsured rate between white, African American, and Asian/Pacific Islander Californians — a major shift since 2013. Overview of U.S. Healthcare System Landscape . Vice President, Health Care Coverage and Access, The Commonwealth Fund, Senior Scientist, Tracking Health System Performance, The Commonwealth Fund. campaign, which seeks to reduce disparities in blood pressure control by empowering people to monitor their own blood pressure and encouraging others in their networks to do so. For more information about Mamatoto Village, read our interview with Nedhari. The city’s role in desegregating health care is less well known. They noted how the obvious divisions — gentrified blocks with nice cafes and rehabbed housing occupied by mostly white, middle-class residents, and weedy blocks with deteriorated housing occupied by mostly black and Latino poor residents — affected their patients’ health. The QDR tracks care delivered by providers in many types of healthcare settings. As part of the effort, which spanned eight regions, Kaiser Permanente’s clinicians sought to counter misconceptions reported by some black patients that dying from high blood pressure is “natural” by encouraging clinicians to be clear about the risks and dogged in their efforts to encourage patients to come in for treatment. Most of our examples relate to health disparities among black patients; we’ll delve into health disparities among Hispanics in a future issue. September 27, 2018 Martha Hostetter and Sarah Klein Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. By Martha Hostetter and Sarah Klein—Sept. Racial and Ethnic Disparities by Gender in Health Care in Medicare Advantage Patterns of racial and ethnic differences in patient experience varied some between women and men, compared with the differences that were observed among both groups combined (see Figure 4). Research Article Health Affairs Vol.38 No.7 Racial And Ethnic Disparities In Care Following The New York State Sepsis Initiative The report is produced with the help of an Interagency Work Group led by AHRQ. A slide presentation (PPT, 6.8 MB) is also available and can be downloaded free of charge. “We have done a lot of community education since,” leading to a mix of patients that is more representative of the community. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. director of community health programs, Southern Jamaica Plain Health Center, Consulting Writer and Editor, Pear Tree Communications, Harkness Fellowships in Health Care Policy and Practice, Association of Health Care Journalists Fellowships, Commonwealth Fund Fellowships in Minority Health, Greensboro Health Disparities Collaborative, Socioeconomic status, education, and other factors, Equity and Structural Racism: Challenges and Opportunities for Healthcare. BY: KATHY CURRAN, JD. in 2017, compared with 6.07 lbs. While something like cancer screening happens once every few years, chronic care management “requires a continuous care relationship that builds around issues of trust,” he says. This exploration, which included convening a group of white and black teens in a racial justice leadership project, led to a number of initiatives, including: offering training for its 100 staff, others at Brigham and Women’s hospital, and community partners to understand the history and current impacts of racism; creating a shared glossary of terms related to racism and other forms of injustice; partnering with nonprofits; and advocating for policy changes to address the root causes of racial health inequities. The Electronic Health Record and Health IT to Decrease Racial/Ethnic Disparities in Care. If you have questions about printing or copying, contact Doreen Bonnett at 301-427-1899 or doreen.bonnett@ahrq.hhs.gov. Socioeconomic status, education, and other factors do not appear to protect black women from this risk, while factors including smoking, drug abuse, and obesity do not explain the differences. To reduce racial and ethnic health disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long‐standing disparities. Many said they had experienced discrimination in a health care setting, with several stories relating to women’s experiences with breast cancer treatment. (One of Simkins’ patients had an abscessed tooth and needed surgery; Greensboro’s black hospital didn’t have space for him and the whites-only hospitals refused to treat him.) Minneapolis-based HealthPartners, which has been stratifying data on its patients’ experiences and outcomes by race and ethnicity for more than a dozen years, found that rates of screening for colorectal cancer among minority patients lagged rates among white patients (in 2009, 43% of patients of color who were candidates for screening completed it vs. 69.2% of white patients). “I talked with her about how her care team did not want to see her or any patient suffer and we’re here to do whatever is needed to care for her.”. They also have worse health outcomes for certain conditions. 2018;29(1):58-62. doi: 10.1353/hpu.2018.0006. Affordable, quality health care. The group then conducted a study exploring how widespread such experiences were, and whether they affected breast cancer treatment outcomes. Kaiser Permanente also has focused on disparities that have a high cost in terms of illness and death. 2018 Oct;101(10):1753-1760. doi: 10.1016/j.pec.2018.05.022. Staff and members of the collaborative also mapped out the steps of cancer treatment, from diagnosis through treatment and recovery, and then interviewed patients to understand points of breakdown. At HealthPartners, “key equity measures are built into our scorecards, our health equity sponsor group meets regularly, and equity is a standing topic at every board of directors’ quality committee meeting. HealthPartners hopes to continue building on this momentum and has plans for continued FIT mailings. However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). All Rights Reserved. Our nation and our health care system are grappling with the issue of health equity. The health system has trained more than 170 “equitable care champions,” employees who go through training on implicit bias and cultural humility and then take responsibility for explaining the rationale for equity initiatives to colleagues. In 2000, the U.S. Department of Health and Human Services launched Healthy People 2010, which had two broad goals: to improve the overall health status of Americans and to eliminate racial and ethnic health care disparities. Epub 2018 May 31. Many health care organizations partner with community advisory boards or collect patient-reported experiences and outcome measures to identify potential problems. Rockville, MD 20857 In a review, Moffitt Cancer Center in Tampa, Fla., discovered minorities were unrepresented not only in their clinical trials — a national phenomenon — but as patients. We don’t have the power to control national policy or address all these big forces,” says Tom Kieffer, executive director of Southern Jamaica Plain Health Clinic. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and… Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long‐standing disparities. As a first step in addressing these disparities, all staff members at the two cancer centers were offered training from the Racial Equity Institute, which included sessions on racial disparities documented in the national cancer registry and the roles of racial bias and gatekeeping in health care. Nearly 17 years have passed since the Institute of Medicine (IOM) released its landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which summarized the scientific evidence on health disparities at the time. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. “The model did not make it easy for a patient going through a traumatic experience.” The navigators worked with patients for up to three years, from diagnosis through treatment and recovery. Southern Jamaica Plain Health Center convened teen workshops to gain insights about the struggles they face, while Cone Health tapped cancer survivors’ expertise to identify ways the health system didn’t serve them. These examples illustrate the benefits of studying racial and ethnic differences in health care treatment and outcomes, conducting ethnographic research to get at the root causes, educating staff about the impacts of bias and structural racism, and making deliberate efforts to earn patients’ trust. In an effort to achieve health equity in maternal morbidity and mortality, a workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed this concept article as background material for the Reduction of Peripartum Racial and Ethnic Disparities Patient Safety Bundle (http://safehealthcareforeverywoman.org/patient-safety-bundles/reduction-of-peripartum-racialethnic-disparities/), the use of which is designed to reduce racial and ethnic disparitie… Cone Health CEO Terry Akin shakes the hand of Alvin Blount, M.D., one of the plaintiffs in the 1963 Simkins v. Moses H. Cone Hospital Supreme Court decision that — along with Medicare regulations, the Civil Rights Act, and other policies — desegregated hospitals in the South. Altogether, the gap in screening rates between white patients and patients of color narrowed significantly, from 77.7 percent for white patients to 70.1 percent for patients of color. 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