Physicians’ Experiences and Opinions Regarding Strategies to Improve Care for Minority Patients

Objective: To assess the views and experiences of a select group of physicians interested in minority health issues regarding promising strategies to improve minority care. Methods: Physicians were asked to respond to a 17-item survey assessing the level of agreement, frequency of implementation of and interest in learning more about 7 promising strategies for alleviating disparities. Results: Most physicians (75-95%) agreed that the 7 proposed strategies could be useful to improve the quality of care provided to minority patients, but only 40-66% of physicians had implemented the strategies sometimes or often in their practices. Between 22 and 29% of physicians were interested in learning more about 6 of the 7 strategies, preferably by CME, seminars and newsletters. Conclusion: Physicians concerned with minority health issues agree that commonly suggested strategies for eliminating racial and ethnic disparities in health care could be useful, but have difficulty implementing such approaches

Improving Quality and Achieving Equity: A Guide for Hospital Leaders

Outlines the need to address racial/ethnic disparities in health care, highlights model practices, and makes step-by-step recommendations on creating a committee, collecting data, setting quality measures, evaluating, and implementing new strategies

Compendium of Cultural Competence Initiatives in Health Care

Public and private sector organizations are involved in a number of activities that seek to reduce cultural and communication barriers to health care. These activities are often described as cultural competency and/or cross-cultural education. A recent Institute of Medicine report recommended that the health care system pursue several of these techniques as part of a multi-level strategy to reduce racial and ethnic disparities in medical care. To address this need, the Henry J. Kaiser Family Foundation has developed a compendium, as a first attempt to describe these activities in a single document. The compendium was prepared in response to the many requests from the media and others to define cultural competency and identify efforts underway in this emerging field. The initiatives included in the compendium are from 1990 to the present and it is divided into two categories: Public Sector Initiatives (Federal/state/local) and Private Sector Initiatives (health care institutions or professional organizations, foundations, academic institutions/policy research organizations, and other). This resource also includes brief definitions for the major terms, organizational descriptions of initiatives and a list of experts in the field

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Ensuring High-Quality Specialty Care

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 3: "Ensuring High-Quality Specialty Care"New efforts to mitigate provider implicit bias, establish culturally-competent care, and leverage quality improvement approaches help identify and eliminate disparities in care

Study Protocol: A Randomized Controlled Trial of Patient Navigation-Activation to Reduce Cancer Health Disparities

Abstract Background Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation) are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and activation to improve cancer treatment. Methods/Design The Rochester Patient Navigation Research Program (PNRP) is a National Cancer Institute-sponsored, patient-level randomized trial (RCT) of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancer patients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews) or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. Discussion This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. Trials Registration clinicaltrials.gov identifier NCT00496678http://deepblue.lib.umich.edu/bitstream/2027.42/78254/1/1471-2407-10-551.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78254/2/1471-2407-10-551.pdfPeer Reviewe

New England Regional Health Equity Profile & Call to Action

Good health is a foundation that allows people to participate in the most important aspects of life. The purpose of the New England Regional Health Equity Profile and Call to Action is to identify where differences in good health exist among racial, ethnic, and disability populations in New England as well as foster policy, programmatic, and individual action to combat health disparities and achieve health equity for racial, ethnic, disability and underserved populations in New England. The report was written by the members of the New England Regional Health Equity Council (RHEC), one of ten regional health equity councils formed by the Office of Minority Health at the federal Department of Health and Human Services. The mission of the New England RHEC is to achieve health equity for all through collective action in the New England region. The New England RHEC’s vision is to achieve health equity through cross-sector interaction and collaboration of activities and resources to optimize health for all where they live, learn, work, and play. The New England Regional Health Equity Profile and Call to Action uses a “social determinants of health” approach. A social determinants of health approach focuses on understanding how the intersection of the social and physical environments; individual behaviors; and access to education, income, healthy foods and health care, impacts a wide range of health and quality-of-life outcomes. The report examines the following topics: Socio-Economic Status, Healthy Eating and Physical Activity, Risky Behaviors, Cultural Competency in Health Care, Health Care Access, Health Outcomes, and the Intersection of Race/Ethnicity & Disability. It also includes a description of State Health Equity Activities and a Regional Call to Action

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

Higher Quality at Lower Cost: Community Health Worker Interventions in the Health Care Innovation Awards

Background: Published evidence regarding cost savings, reduced utilization, and improved quality associated with employing community health workers (CHWs) is largely lacking. This paper presents findings from the Centers for Medicare & Medicaid Services Health Care Innovation Awards (HCIA), with a focus on six diverse programs that employ CHWs. We examine outcomes associated with programs incorporating CHWs into care teams for a broad age range of patients with various health issues such as cancer, asthma, and complex conditions. Methods: This mixed-methods study used data from claims and site visits to assess the effectiveness of CHW programs. In difference-in-differences analyses of Medicare fee-for-service and Medicaid claims, we compared utilization and spending for beneficiaries participating in each CHW program with propensity score matched non-participant beneficiaries for baseline (2010 – 2012) and post-intervention (2013 – 2016). We adjusted for geographic area, prior utilization, and clinical and sociodemographic characteristics. We assessed changes in care quality through beneficiary focus groups and interviews with program leadership and staff. Results: Five of the six programs saw a significant reduction in utilization and/or spending relative to a comparison group, and all programs had positive qualitative findings regarding quality of care. In three of the six programs, the adjusted total cost of care was significantly reduced (-$143 to -$2,044 per beneficiary quarter). We hypothesize that some reductions in spending can be attributed to CHWs’ provision of enhanced access outside of regular clinic hours, which facilitated patient adherence to evidence-based treatment pathways and averted unnecessary ED visits and hospitalizations. Culturally competent CHW encounters engaged patients in health care decisions, generated confidence in their decisions, encouraged adherence to treatment pathways, and mitigated social barriers to care. Conclusions: Programs were associated with improved quality and reductions in health care utilization and spending up to $20,000 per patient over the three-year period. Findings suggest a strong business case for the use of CHWs as part of interdisciplinary teams as CHW programs can provide a significant return on investment for payers. Reimbursement policies that do not account for the services of non-clinical staff such as CHWs impede the sustainability and spread of these interventions, despite mounting evidence of CHWs’ effectiveness. Organizations looking to integrate CHWs into care delivery may conduct feasibility assessments of available workforce and the capacity for clinical oversight, physician buy-in, and funding sustainability. Established programs could be leveraged for mentorship

Eliminating Mental and Physical Health Disparities Through Culturally and Linguistically Centered Integrated Healthcare

Since the U.S. Surgeon General’s report on mental health (1999) declared mind and body to be inseparable, integrated healthcare, bringing the body and mind back together, has been gaining significant momentum across the nation as a preferred approach to care for people with co-morbid physical health and mental health conditions. Primary care settings often are the gateway to healthcare for racial and ethnic minority populations and individuals with limited English proficiency (LEP) and, as such, it has become the portal for identifying undiagnosed or untreated behavioral health disorders. An integrated holistic philosophical approach to behavioral healthcare provides an opportunity to address mental and physical health disparities and achieve health equity through a culturally and linguistically centered integrated healthcare delivery model that by definition must be person-centered, family-centered, and community-centered

Physicians\u27 Perceptions of Cultural Competence in Health Care

Health care disparities continue to impact racial and ethnic minorities in the United States. These disparities may become even more predominant as the population of immigrants and racial and ethnic minorities increases in the country. Health care policymakers, administrators, accreditation bodies, and academia support the practice of cultural competence as a strategy to reduce both health and health care disparities among racial and ethnic minority populations. Yet, although cultural competence strategies have been developed and supported, they are often not implemented by physicians. Researchers need to explore physicians\u27 perspectives of cultural competence in order to increase physician engagement and inform academia, policymakers, accrediting bodies, and administrators as to ways to increase physician buy-in and improve cultural competence in health care