Strategies for Improving the Diversity of the Health Professions

Evaluates programs and strategies that were designed to increase the number of underrepresented African Americans, Native Americans, and Latinos in the health professions in California. Includes recommendations

El mundo caótico del director(a) de un programa de enfermería

Aim: The environment of the nursing program dean or director within a community college or state university can be politically, fiscally, and emotionally challenging. There are few studies that investigate that environment. The purpose of this study was to describe the major barriers and incentives facing these nursing deans or directors as they implemented their proposed interventions related to the Central Valley Nursing Diversity Project. Additionally, we sought to identify successful strategies used to keep the programs competitive for resources and status within their institutions and within their local communities. Methodology: The study is descriptive; the data collection method was structured interviews and data were analyzed using content analysis. Findings: Findings indicate that among the most difficult barriers faced by the directors and the faculty was the over subscribed status (more applicants than positions) of the programs. The deans or directors described three significant points that acted as barriers. These were 1) limited space in science laboratory pre-requisite courses, 2) limited classroom space in nursing courses, and 3) limited space in clinical (hospital) sites. The largest single external pressure reported was the reduction in funding and all deans or directors indicated they had difficulty hiring qualified or credentialed faculty. Conclusion: Colleges must manage more effectively student demand by modifying admissions criteria to be more selective and admit students with greater likelihood of graduating; encourage innovative partnerships between employers and schools of nursing; and increasing funding for nursing faculty salaries, classrooms, and laboratories. Objetivo: El ambiente de un(a) decano(a) o director(a) o de un Programa de Enfermería en un colegio comunitario o una universidad estatal puede ser un reto político, físico y emocional. Hay pocos estudios que investiguen ese ambiente. El propósito de este estudio fue describir las principales barreras e incentivos que enfrentan las(os) decanas(os) o directoras(es) al implementar las intervenciones del Proyecto de Diversidad en Enfermería en el Valle Central. Adicionalmente, se identificaron estrategias exitosas para mantener competitivos a los programas en cuanto a recursos y estatus en las comunidades locales. Metodología: El estudio es descriptivo; la información se recolectó mediante entrevistas estructuradas y fue analizada mediante análisis de contenido. Hallazgos: La barrera más difícil fue la demanda exagerada de los programas. Las(os) decanas(os) o directoras(es) describieron tres barreras significativas: 1) espacio limitado en laboratorios de ciencias para los cursos pre-requisito, 2) espacio limitado en los salones de clase para los cursos de enfermería, 3) espacio limitado en los sitios de práctica clínica. La principal presión externa fue la reducción de financiación, lo que produce dificultades para conseguir docentes calificados. Conclusión: Las instituciones deben manejar más efectivamente la demanda estudiantil, modificar los criterios de admisión para hacerlos más selectivos y admitir estudiantes con mayor posibilidad de graduarse; promover alianzas innovadoras entre empleadores y escuelas de enfermería e incrementar la financiación para salarios de docentes, aulas de clase y laboratorios

The Role of Medical Education in Reducing Health Care Disparities: The First Ten Years of the UCLA/Drew Medical Education Program

BACKGROUND: The University of California, Los Angeles (UCLA)/Charles R. Drew University Medical Education Program was developed to train physicians for practice in underserved areas. The UCLA/Drew Medical Education Program students receive basic science instruction at UCLA and complete their required clinical rotations in South Los Angeles, an impoverished urban community. We have previously shown that, in comparison to their UCLA counterparts, students in the Drew program had greater odds of maintaining their commitment to medically disadvantaged populations over the course of medical education. OBJECTIVE: To examine the independent association of graduation from the UCLA/Drew program with subsequent choice of physician practice location. We hypothesized that participation in the UCLA/Drew program predicts future practice in medically disadvantaged areas, controlling for student demographics such as race/ethnicity and gender, indicators of socioeconomic status, and specialty choice. DESIGN: Retrospective cohort study. PARTICIPANTS: Graduates (1,071) of the UCLA School of Medicine and the UCLA/Drew Medical Education Program from 1985–1995, practicing in California in 2003 based on the address listed in the American Medical Association (AMA) Physician Masterfile. MEASUREMENTS: Physician address was geocoded to a California Medical Service Study Area (MSSA). A medically disadvantaged community was defined as meeting any one of the following criteria: (a) federally designated HPSA or MUA; (b) rural area; (c) high minority area; or (d) high poverty area. RESULTS: Fifty-three percent of UCLA/Drew graduates are located in medically disadvantaged areas, in contrast to 26.1% of UCLA graduates. In multivariate analyses, underrepresented minority race/ethnicity (OR: 1.57; 95% CI: 1.10–2.25) and participation in the Drew program (OR: 2.47; 95% CI: 1.59–3.83) were independent predictors of future practice in disadvantaged areas. CONCLUSIONS: Physicians who graduated from the UCLA/Drew Medical Education Program have higher odds of practicing in underserved areas than those who completed the traditional UCLA curriculum, even after controlling for other factors such as race/ethnicity. The association between participation in the UCLA/Drew Medical Education Program and physician practice location suggests that medical education programs may reinforce student goals to practice in disadvantaged communities

Counterproductive Messaging About COVID-19 Safety Measures in Cancer Screening Outreach: Results of a Pragmatic Randomized Trial

COVID-19 has caused patients to defer preventive services. We conducted a pragmatic randomized trial of incorporating a message about COVID-19 safety measures into an automated telephonic outreach program targeting primary care patients overdue for cancer screening. Contrary to our hypothesis, the COVID-19 safety measure messaging resulted in significantly fewer patients in the intervention group requesting scheduling of preventive services (135 of 196 patients reached (68.9%)), compared with the standard call script group (165 of 207 patients (79.7%)), (p=0.01). Messages intended to reassure patients about the safety of obtaining in-person preventive services during the coronavirus pandemic may have unintended consequences.http://deepblue.lib.umich.edu/bitstream/2027.42/166320/1/AFM-54-21_PP.pdfDescription of AFM-54-21_PP.pdf : Main ArticleSEL

Do Physicians with Self-Reported Non-English Fluency Practice in Linguistically Disadvantaged Communities?

BackgroundLanguage concordance between physicians and patients may reduce barriers to care faced by patients with limited English proficiency (LEP). It is unclear whether physicians with fluency in non-English languages practice in areas with high concentrations of people with LEP.ObjectiveTo investigate whether physician non-English language fluency is associated with practicing in areas with high concentrations of people with LEP.DesignCross-sectional cohort study.ParticipantsA total of 61,138 practicing physicians no longer in training who participated in the California Medical Board Physician Licensure Survey from 2001-2007.MeasuresSelf-reported language fluency in Spanish and Asian languages. Physician practice ZIP code corresponding to: (1) high concentration of people with LEP and (2) high concentration of linguistically isolated households.MethodsPractice location ZIP code was geocoded with geographic medical service study designations. We examined the unadjusted relationships between physician self-reported fluency in Spanish and selected Asian languages and practice location, stratified by race-ethnicity. We used staged logistic multiple variable regression models to isolate the effect of self-reported language fluency on practice location controlling for age, gender, race-ethnicity, medical specialty, and international medical graduate status.ResultsPhysicians with self-reported fluency in Spanish or an Asian language were more likely to practice in linguistically designated areas in these respective languages compared to those without fluency. Physician fluency in an Asian language [adjusted odds ratio (AOR) = 1.77; 95% confidence intervals (CI): 1.63-1.92] was independently associated with practicing in areas with a high number of LEP Asian speakers. A similar pattern was found for Spanish language fluency (AOR = 1.77; 95% CI: 1.43-1.82) and areas with high numbers of LEP Spanish-speakers. Latino and Asian race-ethnicity had the strongest effect on corresponding practice location, and this association was attenuated by language fluency.ConclusionsPhysicians who are fluent in Spanish or an Asian language are more likely to practice in geographic areas where their potential patients speak the corresponding language

Achieving Health Equity Through Community Engagement in Translating Evidence to Policy: The San Francisco Health Improvement Partnership, 2010–2016

BACKGROUND: The San Francisco Health Improvement Partnership (SFHIP) promotes health equity by using a novel collective impact model that blends community engagement with evidence-to-policy translational science. The model involves diverse stakeholders, including ethnic-based community health equity coalitions, the local public health department, hospitals and health systems, a health sciences university, a school district, the faith community, and others sectors. COMMUNITY CONTEXT: We report on 3 SFHIP prevention initiatives: reducing consumption of sugar sweetened beverages (SSBs), regulating retail alcohol sales, and eliminating disparities in children’s oral health. METHODS: SFHIP is governed by a steering committee. Partnership working groups for each initiative collaborate to 1) develop and implement action plans emphasizing feasible, scalable, translational-science–informed interventions and 2) consider sustainability early in the planning process by including policy and structural interventions. OUTCOME: Through SFHIP’s efforts, San Francisco enacted ordinances regulating sale and advertising of SSBs and a ballot measure establishing a soda tax. Most San Francisco hospitals implemented or committed to implementing healthy-beverage policies that prohibited serving or selling SSBs. SFHIP helped prevent Starbucks and Taco Bell from receiving alcohol licenses in San Francisco and helped prevent state authorization of sale of powdered alcohol. SFHIP increased the number of primary care clinics providing fluoride varnish at routine well-child visits from 3 to 14 and acquired a state waiver to allow dental clinics to be paid for dental services delivered in schools. INTERPRETATION: The SFHIP model of collective impact emphasizing community engagement and policy change accomplished many of its intermediate goals to create an environment promoting health and health equity

A proposed systems approach to the evaluation of integrated palliative care

<p>Abstract</p> <p>Background</p> <p>There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care.</p> <p>Methods</p> <p>In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors.</p> <p>Results</p> <p>The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network.</p> <p>Conclusions</p> <p>Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations.</p