Belonging: The Social Dynamics of Fitting In as Experienced by Hmong Refugees in Germany and Texas, by Faith G. Nibbs

Belonging: The Social Dynamics of Fitting In as Experienced by Hmong Refugees in Germany and Texas by Faith G. Nibbs Durham, NC: Carolina Academic Press, 201

Crossing Borders in Birthing Practices: A Hmong Village in Northern Thailand (1987-2013)

Background: Over the past several decades in Northern Thailand, there has been a contest of authoritative knowledge between the Hmong traditional birth system and the Thai biomedical maternity system. In this paper, we explore the contest in one Hmong village by describing the traditional and biomedical practices; families’ birth location choices; and elements of authoritative knowledge. Methods: We built on a village survey and conducted an ethnographic qualitative case study of 16 families who made different pregnancy care choices. Results: The contest is being won by the Thai biomedical system, as most families deliver at the hospital. These families choose hospital births when they evaluate problems or potential problems; they have more confidence in the superior Thai biomedical system with its technology and medicines than in the inadequate Hmong traditional system. But the contest is ongoing, as some families prefer to birth at home. These families choose home births when they want a supportive home environment; they embrace traditional Hmong birth knowledge and practices as superior and reject hospital birth practices as unnecessary, harmful, abusive, and inadequate. Despite their choice for any given pregnancy, the case study families feel the pull of the other choice: hospital birth families lament loss of the home environment and express their dislike of hospital practices; and home birth families feel the anxiety of potentially needing quick obstetrical assistance that is far away. Conclusion: While most families choose to participate in the Thai biomedical system, they also use Hmong pregnancy and postpartum practices, and some families choose home births. In this village, the contest for the supremacy of authoritative birth knowledge is ongoing

Primary care clinicians’ perspectives about quality measurements in safety-net clinics and non-safety-net clinics

Abstract Background Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition’s Quality Measurement Enhancement Project sought to collect data from primary care providers’ (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs’ perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare. Methods Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes. Results Three themes with sub-themes emerged. Theme #1: Minnesota’s current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity. Conclusion Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs’ perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them

SPIRIT checklist.

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