Eliminating Healthcare Disparities in America (eBook)

About the Editor 7
Foreword 9
Contents 11
Preface 14
Introduction 17
I UNDERLYING CAUSES OF HEALTHCARE DISPARITIES 25
Historical Perspectives of Healthcare Disparities 26
INTRODUCTION 26
ROOTS 26
SHACKLES AND CHAINS 31
RECONSTRUCTION OR DECONSTRUCTION? 32
FIFTY CENTURIES OF BLACKS IN MEDICINE 33
GOVERNMENTAL INVOLVEMENT IN HEALTHCARE FOR BLACKS 35
RACIAL AND ETHNIC DIFFERENCES IN DISEASE EXPRESSION 38
CONCLUSION 40
REFERENCES 40
Epidemiology of Racial and Ethnic Disparities in Health and Healthcare 43
INTRODUCTION 43
RACE AND ETHNICITY IN THE UNITED STATES 44
CONCEPT OF DISPARITIES AND THE HEALTHY PEOPLE 2010 GOALS 44
THE BURDEN OF HEALTH DISPARITIES 46
DISPARITIES IN ACCESS TO AND QUALITY OF CARE 54
LIMITATIONS AND CHALLENGES IN RACIAL AND ETHNIC COMPARISONS OF HEALTHCARE DATA 56
UNIQUE OPPORTUNITIES FOR THE FUTURE 59
CONCLUSIONS 59
REFERENCES 60
Cultural Diversity in Medicine and in Healthcare Delivery 63
INTRODUCTION 63
DEFINITION OF TERMS 64
THE DIVERSE PATIENT UNIVERSE IN AMERICA 64
CORONARY HEART DISEASE IN AFRICAN AMERICANS 70
HYPERTENSION IN AA 72
HEART FAILURE IN AA 73
DIABETES MELLITUS (DM) IN AA 74
CEREBROVASCULAR DISEASE IN AA 74
END-STAGE RENAL DISEASE (ESRD) IN AA 76
CONCLUSION 81
GLOSSARY OF KEY TERMS 82
REFERENCES 83
Healthcare and the Politics of Race 88
INTRODUCTION 88
STRAW MEN 90
SUBSIDIES AND MORALS: WHEN ARE RACIAL DIFFERENCES WRONG? 94
TOWARD COMMON GROUND SOLUTIONS 100
REFERENCES 102
Barriers to Eliminating Disparities in Clinical Practice 104
INTRODUCTION 104
THE IOM REPORT “UNEQUAL TREATMENT” 106
KEY CLINICAL LESSONS FROM THE IOM REPORT “UNEQUAL TREATMENT” 107
WHERE DO WE GO FROM HERE? 111
CONCLUSION 114
REFERENCES 114
Second-Class Medicine 119
INTRODUCTION 119
MISSING EVIDENCE OF EBM 122
APPLICATION OF EBM TO DRUG REVIEWS AND HEALTH COVERAGE POLICY 127
APPLICATION OF EBM TO REDUCING HEALTHCARE DISPARITIES 132
CONCLUSION 136
ACKNOWLEDGMENT 137
REFERENCES 137
The Diversity Benefit 141
INTRODUCTION 141
DOES DIVERSITY MAKE A DIFFERENCE? 142
STRATEGIES TO INCREASE DIVERSITY IN THE HEALTH PROFESSIONS 149
CONCLUSION 154
REFERENCES 155
III APPROACHES TO CORRECTING THE PROBLEMS 158
Eliminating Disparities in Healthcare Through Quality Improvement 159
INTRODUCTION 159
HEALTH DISPARITIES VS HEALTHCARE DISPARITIES 160
DISPARITIES IN HEALTH 160
DISPARITIES IN HEALTHCARE 162
ROLE OF QI 166
QI TOOLS 168
SUCCESSFUL MODELS 172
CURRENT QI DISPARITY INITIATIVES 180
GETTING STARTED 181
CONCLUSION 182
REFERENCES 182
Eliminating Racial Discrimination in Healthcare 197
INTRODUCTION 197
CONCLUSION 205
REFERENCES 206
Quality of Care and Health Disparities 215
INTRODUCTION 215
HISTORICAL MILESTONES IN THE GOVERNMENT’S RESPONSE TO MINORITY HEALTH ISSUES 217
A TURNING POINT IN HISTORY: THE 1985 SECRETARY’S TASK FORCE ON BLACK AND MINORITY HEALTH 219
THE FEDERAL OMH 220
OTHER MINORITY HEALTH PROGRAMS WITHIN DHHS 222
THE STATES’ ROLES IN ELIMINATING DISPARITIES 224
GOVERNMENT SUPPORT OF MINORITY EDUCATIONAL INSTITUTIONS AND HEALTH PROFESSIONALS 226
THE EMERGENCE OF QUALITY AS A KEY FACTOR IN ELIMINATING DISPARITIES 227
FUTURE TRENDS AND CHALLENGES 230
SUMMARY 233
REFERENCES 233
The Role of Communities in Eliminating Healthcare Disparities 238
INTRODUCTION 238
WHAT IS “THE COMMUNITY”? 240
THE ROLE OF COMMUNITIES IN DETERMINING HEALTH STATUS 240
COMMUNITY INITIATIVES TO ELIMINATE HEALTH DISPARITIES 244
SUMMARY 251
REFERENCES 251
The Potential Impact of Performance Incentive Programs on Racial Disparities in Healthcare 254
INTRODUCTION 254
EQUITY IS A PART OF QUALITY 254
PERFORMANCE INCENTIVE PROGRAMS 255
POTENTIAL IMPACT ON DISPARITIES 258
EVIDENCE 261
BASIC PROGRAM FEATURES—DISPARITY HIGHLIGHTS 263
SUMMARY RECOMMENDATIONS 265
ACKNOWLEDGMENT 268
REFERENCES 268
IV EXAMPLES OF WHAT WORKS 274
Monitoring Socioeconomic Determinants for Healthcare Disparities 275
INTRODUCTION 275
PUBLIC HEALTH DISPARITIES GEOCODING PROJECT: PURPOSE, PERSPECTIVE, AND CONTEXT 276
PUBLIC HEALTH DISPARITIES GEOCODING PROJECT: STUDY DESIGN AND KEY RESULTS 281
IMPLICATIONS OF THE PROJECT FOR MONITORING AND ANALYZED HEALTHCARE DISPARITIES 312
CONCLUSION: DATA, POLITICS, AND HEALTH INEQUITIES 315
ACKNOWLEDGMENTS 315
REFERENCES 316
The Association of Black Cardiologists 323
INTRODUCTION 323
INTERNAL STRUCTURE 324
FINANCIAL STATUS 326
SPECIAL ABC INITIATIVES 326
MEMBER PARTICIPATION AND VOLUNTEER INVOLVEMENT 328
CONCLUSION 328
ACKNOWLEDGMENT 328
IV EXAMPLES OF WHAT WORKS 274
Breathe Easy in Seattle 329
INTRODUCTION 329
THE SEATTLE-KING COUNTY HEALTHY HOMES PROJECT ( 1997 – 2001) 332
THE BREATHE EASY HOMES PROGRAM (2003–2007) 342
CONCLUSION 348
ACKNOWLEDGMENTS 349
REFERENCES 349
Access Health Solutions 356
INTRODUCTION 356
THE METHOD 358
THE SCOPE OF THE STUDY 359
THE RATIONALE OF THE STUDY 359
RESULTS OF AHS PATIENT SATISFACTION SURVEY 363
FINDINGS 369
CONCLUSIONS 375
REFERENCES 376
Carolinas Association for Community Health Equity-CACHE 379
INTRODUCTION 379
DEFINING RACIAL AND ETHNIC HEALTHCARE DISPARITIES 379
DEMOGRAPHICS: MECKLENBURG COUNTY 380
HISTORICAL PERSPECTIVE 380
HISTORY OF EFFORTS TO ADDRESS HEALTH DISPARITIES IN MECKLENBURG COUNTY 381
EVOLUTION OF THE MODEL 383
FUTURE DIRECTIONS 386
ACKNOWLEDGMENTS 388
Principles for Eliminating Racial and Ethnic Disparities in Healthcare 390
INTRODUCTION 390
PRINCIPLE 1: PROVIDE INSURANCE COVERAGE AND ACCESS TO HIGH- QUALITY CARE FOR ALL AMERICANS 391
PRINCIPLE 2: PROMOTE A DIVERSE HEALTHCARE WORKFORCE 393
PRINCIPLE 3: DELIVER PATIENT-CENTERED CARE 394
PRINCIPLE 4: MAINTAIN ACCURATE AND COMPLETE RACE/ ETHNICITY DATA TO MONITOR DISPARITIES IN CARE 395
PRINCIPLE 5: SET MEASURABLE GOALS FOR IMPROVING QUALITY AND ENSURE THAT GOALS ARE ACHIEVED EQUITABLY FOR ALL RACIAL AND ETHNIC GROUPS 396
CONCLUSION 398
REFERENCES 399
Index 403