Addressing Health Disparities Through Organizational Change - Evaluation Report

In the coming decades, racial and ethnic minorities will constitute more than 50% of many states' populations -- including that of Colorado. Individuals of racial and ethnic minority status are disproportionally affected by disease and disability and have poorer health outcomes than do their white counterparts.1,2 These differences are disparaties in health. Even when minorities have the same insurance status, access, age income and chronic conditions, they still tend to receive lower-quality health care than the white population. Differences in access and quality constitute disparities in health care.3 Shifts in population, coupled with current inequalities in health status and quality of care, clearly establish the need for addressing these disparities.Recognizing the persistence of racial and ethnic health disparities, The Colorado Trust developed the Equality in Health Initiative in 2005. The Initiative provided funding for 14 organizations across the state of Colorado in the first funding cycle, supporting their efforts to reduce health disparities by addressing the needs of racial and ethnic minorities. The initiative intended to strengthen organizations' cultural competency so as to promote and ensure the following for racial and ethnic minority populations: 1) equality in treatment and medical services, 2) attainment of equal access to health care, 3) improvements of environmental conditions and 4) increased healthy behaviors. Grantees received technical assistance in three areas: cultural competency; program planning and implementation related to health disparities; and data collection and evaluation.The Colorado Trust believed if grantee organizations' culturally competent practices improved through technical assistance, interventions and networking then short term health outcomes would improve as well, ultimately leading to reductions in health disparities. This evaluation examined this conceptual model to determine the role organizational cultural competency played in improving short-term health and health care outcomes for racial and ethnic minority groups.Results showed that as grantees' cultural competency in the form of community relationships improved, so did their adaptations to their interventions as well as short-term health and health care outcomes. Cultural competency in the form of organizational policies and procedures predicted improvements in the short-term health and health care outcomes of service recipients. Based on the results of this evaluation, a new conceptual model was developed and is described in this report. Facilitating and challenging conditions to developing cultural competency are also outlined as well as lessons for funders, policy makers and grantees

Needs Assessment Using Community-Based Collaborative Action Research in an American Indian Community

Community-Based Collaborative Action Research (CBCAR) holds promise when conducting nursing research in Native American communities. This article identifies through review of the literature common issues inherent in conducting traditional research in Native American Communities. The purpose of this article is to share first steps in implementing community- based collaborative action research in a Native American community. It addresses not only issues identified by the community but also provides insight into the future use of CBCAR in other Native American communities

COMMUNITY-BASED PARTICIPATORY RESEARCH TO PARTNER WITH THE CONFEDERATED SALISH AND KOOTENAI TRIBES IN PHARMACOGENETICS RESEARCH

Pharmacogenetics research has advanced our knowledge of the genetic basis of individual drug responses. The aim of pharmacogenetics research is to provide opportunities for the development of strategies aimed at discovering clinically relevant gene-drug pairs. Further benefits stem from the translation of pharmacogenetics research into the clinic to identify patients who are at high risk of adverse drug events. However, American Indian and Alaska Native (AI/AN) populations have not benefited markedly from genetics-guided therapeutics. A key strategy in engaging AI/AN people in pharmacogenetics research has been the implementation of community-based participatory research (CBPR). CBPR is a qualitative research methodology in which a partnership is formed between the research institution and the community under study. CBPR provides a framework for both partners to be involved in all aspects of the research process, from developing research questions to data analysis, and dissemination of research findings. Early in the project, approval was given by the Confederated Salish and Kootenai Tribes (CSKT) through discussions with Tribal Health and Tribal Council to conduct pharmacogenetics research with the CSKT community. Thereafter, a collaborative university-community partnership was established with the CSKT to ensure the community has sufficient knowledge about pharmacogenetics research and to develop culturally-relevant research strategies. We formed an oversight committee, the Community Pharmacogenetics Advisory Council (CPAC), to ensure community involvement. We also held workshops to provide education and bring awareness to the community about pharmacogenetics research. CPAC engagement and education through workshops and research involvement was evaluated through a questionnaire. Seventeen healthcare provider interviews have been conducted, transcribed, and analyzed. The interviews were conducted with Montana healthcare providers to assess their views on the potential benefits and harms of pharmacogenetics research and the feasibility of its future implementation into Tribal Health. In addition, two focus groups have been conducted thus far. CPAC helped design a moderator’s guide and developed recruitment tools for focus groups. These focus group materials were used and will continue to be used to conduct focus groups with enrolled CSKT members who receive their healthcare through Tribal Health to assess their views and perceptions of pharmacogenetics research, its translation into the clinic, and dissemination of results to the broader community. The details of the results of the focus groups and healthcare provider interviews will be described in this study. This collaboration created a CBPR framework that best fits the needs of the community. Engaging CSKT community partners in informal and formal discussions about pharmacogenetics research has aided in identifying priorities of the community and building mutually productive partnership

A Roundtable Conference On Traditional Cultural Advocacy Program

Purpose This report presents results of a two-day Traditional Cultural Advocacy Program (TCAP) Roundtable Conference. The purpose of the TCAP Roundtable was to develop a consensus of the IHS roles and responsibilities in addressing traditional cultural beliefs, values, and practices; and to discuss and identify issues on holistic beliefs in health care as it relates to traditional culture. Methods This report includes consensus statements, highlights from the conference discussions, a list of participants, and the conference agenda. The following were four main objectives identified to be accomplished by the TCAP Roundtable: 1) identify roles and responsibilities of the IHS, tribes, and individuals for addressing traditional cultural beliefs, values, and practices; 2) identify the specific types of policy currently needed by the IHS and recommended content where appropriate; 3) identify holistic beliefs that are generally viewed as those commonly held by the AI/AN throughout the U.S.; and 4) discuss the need, purpose, and objectives of a national conference. Results Consensus statements are provided in the following areas: 1) roles and responsibilities for fostering, supporting and nurturing AI/AN cultural values, beliefs, and traditional health practices into the health care systems for the AI/AN; 2) IHS policy is needed for fostering, supporting, and advocating AI/AN cultural values, beliefs, and traditional healing practices into the health care systems for the AI/AN; 3) approaches to achieve a cooperative spirit between traditional beliefs and healing practices with western medical methods; 4) common traditional values and beliefs among the AI/AN; and 5) research on treatment outcomes of alternative medicine practices. Conclusion This Roundtable Conference may be a catalyst for developing new approaches for building peer relationships among allopathic or western medical health care providers and American Indian and Alaska Native (AI/AN) traditional practitioners/healers. The momentum begun by this Roundtable discussion should continue through the encouragement and support of open dialogue between the IHS and tribal health staff and traditional practitioners and healers

Tuberculosis treatment in high TB / HIV settings : evaluating public-private partnerships in South Africa

The aim of this thesis is to evaluate the perfonnance of different models of publicprivate partnerships in the provision of tuberculosis treatment, and explore incentive mechanisms for private sector participation. It makes recommendations to policymakers in South Africa and elsewhere on the best way to approach a policy on the enhanced role of private sector providers in tuberculosis treatment in light of the HIV/AIDS epidemic. A common framework is used to analyse the nature of the models, their perfonnance in tenns of cost, effectiveness and quality of care, and incentives for private participation. Multiple research methods are employed in order to fully investigate complex situations and to validate the findings. Both quantitative and qualitative methods are used. The study found that the quality of care is superior in both models of public-private partnerships when compared to the purely public sector model of delivery, and shows that increased collaboration with private providers through partnerships could potentially improve the quality of care and increase access to care. The results of the cost-effectiveness show that, in comparison with the purely public provision, the public-private partnership models could significantly reduce costs to both the public health sector and patient, and increase cost-effectiveness of tuberculosis treatment. Private providers in the existing and potential partnerships have both financial and non-financial motivations and incentives for participation in partnership. Overall, these pUblic-private partnerships show that there is a strong economic case for expanding the private sector involvement in tuberculosis treatment in South Africa. Expansion may require increased investment in the public-private partnerships, but they seem to be capable of delivering important improvements in the affordability and efficiency of tuberculosis treatment, and improving the South African health system's capacity to cope with the impact of the HIV/AIDS epidemic

Growing with Purpose: Annual Report, 2023

This report includes the following highlights: WSU and Providence Start New Pediatric Residency in Spokane; Family Medicine Residency Program Welcomes First Residents; Master s in Healthcare Administration and Leadership; College Welcomes Students to Renovated Medical Buildin

HIV IN COMMUNITIES OF COLOR: THE COMPENDIUMOF CULTURALLY COMPETENT PROMISING PRACTICES

Softback manual of compiled resources and best practices in the application and development of effective culturally competent programs in HIV Care delivery.https://dh.howard.edu/nmaetc_pubs/1005/thumbnail.jp

Addressing Depression Among American Indians and Alaska Natives: A Literature Review

This report highlights and reviews literature, programs and activities focused on depression and other common mental health conditions in American Indian and Alaska Native (AI/AN) communities in the United States

A Review of Best Practices for Monitoring and Improving Inpatient Pediatric Patient Experiences.

ContextAchieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge.ObjectiveWe reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care.Data sourcesWe searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO.Study selectionWe included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles.Data extractionTwo researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings.ResultsWe identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices.ConclusionsBoth pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff