The Heart of the Matter: The Relationship Between Communities, Cardiovascular Services and Racial and Ethnic Gaps in Care

As part of an initiative to address racial/ethnic disparities in the diagnosis and treatment of heart disease, examines factors behind the segmentation of healthcare access and service patterns by income and insurance status and its effect on minorities

Focal Spot, Winter 2008/2009

https://digitalcommons.wustl.edu/focal_spot_archives/1110/thumbnail.jp

Creating Equity Reports: A Guide for Hospitals

Offers a framework for equity reporting -- identifying ethnic and racial disparities in hospitals and ways to reduce them -- including implementation, data collection, quality measures, and utilization. Reviews case studies and lessons learned

A Comprehensive Analysis on the Healthcare Systems in Latin America

This comprehensive report summarizes and analyzes the current state of healthcare in Latin America, specifically in the countries of Mexico, Brazil, the Northern Triangle (El Salvador, Guatemala, and Honduras), the Andean Region (Ecuador, Peru, and Bolivia) and the Rioplatense Region (Uruguay, and Argentina). Each country's healthcare system is examined in depth, in terms of health infrastructure, the healthcare providing industry, and the effects of healthcare on the countries' respective populations.Mosser, Michael W.International Relations and Global Studie

Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists.

BackgroundAn alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries.MethodsWe evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed.ResultsRadiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms.ConclusionsGiven the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography

Environmental Implications of the Health Care Service Sector

This report analyzes the environmental effects associated with activities undertaken and influenced by the health care service sector. It is one part of a larger study to better understand the environmental effects of service sector activities and the implications for management strategies. Considerable analysis has documented the service sector's contribution to domestic economic conditions, yet little analysis has been performed on the broad impacts service firms have on environmental quality. For this study the authors developed a framework to examine the nature of service sector industries' influence on environmental quality. Three primary types of influence were identified: direct impacts, upstream impacts, and downstream impacts. In addition, indirect impacts induced by service sector activities include their influence over settlement patterns and indirect influences over other sectors of the economy. In their initial analysis, the authors noted that many functions performed in the service sector also are commonly found in other sectors. The impacts of these activities have been analyzed separately from those unique to the health care sector, as they present different challenges. Health care is one of the largest U.S. industries, employing one in nine workers and costing one in seven dollars generated in the economy. Functions performed in the industry that are common in other sectors include: transportation; laundry; food services; facility cleaning; heating and cooling; and photographic processing. Activities unique to the health care industry include: infectious waste generation and disposal; medical waste incineration; equipment sterilization; dental fillings; ritual mercury usage; x-ray diagnosis; nuclear medicine; pharmaceutical usage and disposal; and drinking water fluoridation. The industry has considerable leverage upstream on its suppliers, which is important to managing risks from the use of goods commonly used in the industry, including: mercury-containing products, polyvinyl chloride plastics, latex gloves, and syringe needles. The authors identified a number of areas for potential environmental management initiatives: controlling emissions from on-site "production" type functions; mercury use; the environmental consequences of infection control measures; pollution prevention through substitution of alternative health care services; and research and data collection.

Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2011

Assesses the U.S. healthcare system's average performance in 2007-09 as measured by forty-two indicators of health outcomes, quality, access, efficiency, and equity compared with the 2006 and 2008 scorecards and with domestic and international benchmarks

Focal Spot, Fall 1978

https://digitalcommons.wustl.edu/focal_spot_archives/1021/thumbnail.jp

Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care