racial and ethnic disparities in health care 2018

In the end, advocates say, it’s important to realize that while racism is a large and multifaceted problem, there are concrete steps health care providers can and should take. The coverage gains that occurred under the ACA reduced percentage point differences in uninsured rates between groups of color and Whites. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. For example, it has reduced the gap between white and black patients with controlled hypertension. OBJECTIVE: To conduct a systematic review of the literature documenting racial/ethnic disparities in quality of care for infants in the NICU setting. Findings: Using National Health Interview Survey data from 1999-2018, we found that insurance coverage increased across all 4 major race/ethnicity groups. They also have worse health outcomes for certain conditions. While the plaintiffs initially lost, they appealed, resulting in the Supreme Court decision, Simkins v. Moses H. Cone Hospital, that set in motion the desegregation of hospitals throughout the South. 2018;29(1):58-62. doi: 10.1353/hpu.2018.0006. “We’re taught that racism is evil so it’s hard to recognize that in ourselves. At HealthPartners, “key equity measures are built into our scorecards, our health equity sponsor group meets regularly, and equity is a standing topic at every board of directors’ quality committee meeting. They also offer lessons about what it may take to go beyond these nascent steps and make the pursuit of health equity a common practice. The health system has trained more than 170 “equitable care champions,” employees who go through training on implicit bias and cultural humility and then take responsibility for explaining the rationale for equity initiatives to colleagues. Interviews with Tampa residents revealed many hadn’t realized they could call and ask for appointments. The Greensboro Health Disparities Collaborative partnered with Cone Health’s Wesley Long Cancer Center and the University of Pittsburgh Medical Center’s Hillman Cancer Center in a project known as ACCURE (Accountability for Cancer Care Through Undoing Racism and Equity). But some experiences are common to many people within these groups, and social determinants of health … We don’t have the power to control national policy or address all these big forces,” says Tom Kieffer, executive director of Southern Jamaica Plain Health Clinic. You’ve probably heard some of the harrowing statistics about racial and ethnic disparities in health care. Overview of U.S. Healthcare System Landscape . Within those areas, access to healthy foods, primary and other quality health care, and environmental conditions have a significant impact on disease development and prevention . PHILADELPHIA — A decade and a half ago, a landmark study explored how racial and ethnic minorities face disparities in health care quality, even after accounting for … Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long‐standing disparities. Cone Health CEO Terry Akin shakes the hand of Alvin Blount, M.D., one of the plaintiffs in the 1963 Simkins v. Moses H. Cone Hospital Supreme Court decision that — along with Medicare regulations, the Civil Rights Act, and other policies — desegregated hospitals in the South. for newborns of mothers who entered the program after giving birth. They noted how the obvious divisions — gentrified blocks with nice cafes and rehabbed housing occupied by mostly white, middle-class residents, and weedy blocks with deteriorated housing occupied by mostly black and Latino poor residents — affected their patients’ health. “Framing it as something that happened to other people might make others feel like they can speak up.” As word spread to patients and other staff about this pilot, they began requesting visits with doctors who were participating. In 2017 there continued to be no statistically significant difference in the nonelderly uninsured rate between white, African American, and Asian/Pacific Islander Californians — a major shift since 2013. Privacy Policy. “We made sure the community had full participation in every step of the research process. “There’s often an assumption in the medical world that racial disparities are due to something genetic, when in fact it might be racism,” says Neel Shah, M.D., assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. J Health Care Poor Underserved. HealthPartners hopes to continue building on this momentum and has plans for continued FIT mailings. Many said they had experienced discrimination in a health care setting, with several stories relating to women’s experiences with breast cancer treatment. This kit focuses on the theme of “Working Together to End Racial and Ethnic Disparities: One Physician at a Time.” Access DVD interviews with physicians, nurses and patients, and a CD of information on topics such as cultural competence and literacy. Rumball-Smith J, Bates DW. In an effort to achieve health equity in maternal morbidity and mortality, a workgroup of the National Partnership for Maternal Safety, within the Council on Patient Safety in Women's Health Care, developed this concept article as background material for the Reduction of Peripartum Racial and Ethnic Disparities Patient Safety Bundle (http://safehealthcareforeverywoman.org/patient-safety-bundles/reduction-of-peripartum-racialethnic-disparities/), the use of which is designed to reduce racial and ethnic disparitie… “The model did not make it easy for a patient going through a traumatic experience.” The navigators worked with patients for up to three years, from diagnosis through treatment and recovery. (One of Simkins’ patients had an abscessed tooth and needed surgery; Greensboro’s black hospital didn’t have space for him and the whites-only hospitals refused to treat him.) “One of the techniques that we learned about early on from one of the residents is to say many of my patients have experienced the effects of racism in health care. Racial and Ethnic Disparities in Care by Gender: All Clinical Care Measures Number of clinical care measures (out of 42) for which women/men of selected racial and ethnic minority groups experienced care that was worse than, similar to, or better than the care experienced by White women/men in 2018 To reduce racial and ethnic health disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. Rockville, MD 20857 Many health care organizations partner with community advisory boards or collect patient-reported experiences and outcome measures to identify potential problems. After this initial research, the collaborative sought to test whether customized supports could improve the experiences of black women undergoing treatment for early-stage breast cancer. © 2020 The Commonwealth Fund. Altogether, the gap in screening rates between white patients and patients of color narrowed significantly, from 77.7 percent for white patients to 70.1 percent for patients of color. Access to health insurance is often the first step in receiving quality, affordable health care. “I talked with her about how her care team did not want to see her or any patient suffer and we’re here to do whatever is needed to care for her.”. In this study, we do so using the Global Assessment of Pediatric Patient Safety (GAPPS) Trigger Tool. Health care access is an important—though not sole—determinant of health outcomes.1 Racial/ethnic minorities face numerous barriers to accessing health services, including living in communities with fewer primary health care providers2 and being less likely to have a usual source of care.3 Equal-access health care systems—which strive to eliminate financial barriers to health care—may potentially mitigate well-documented racial/ethnic mortality disparities in the United States.4 The Veterans Health Administr… However, these disparities have not been examined in a pediatric inpatient environment by using a measure of clinically confirmed adverse events (AEs). The latest report looks at disparities in deaths and illness, use of health care, behavioral risk factors for disease, environmental hazards, and social determinants of health at the national level. Vice President, Health Care Coverage and Access, The Commonwealth Fund, Senior Scientist, Tracking Health System Performance, The Commonwealth Fund. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. List of Measures and Summary of Results for Figures, Appendix A.3. Less directed efforts to improve health outcomes, ones for instance that fail to consider the particular factors that may lead to worse outcomes for blacks, Hispanics, or other patients of color, may not lead to equal gains across groups — and in some cases may exacerbate racial health disparities. To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and racism factor into health care. One of the group’s first activities was to conduct focus groups among black and white members about their health care experiences. Conclusions. The contribution of NICU care to disparities in outcomes is unclear. The annual National Healthcare Quality and Disparities Report is mandated by Congress to provide a comprehensive overview of the quality of healthcare received by the general U.S. population and disparities in care experienced by different racial and socioeconomic groups. Control. The National Healthcare Quality and Disparities Reportassesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Affordable, quality health care. Specially trained ACCURE nurse navigators worked with patients to ensure they understood their treatment options and had financial and social supports. Racial and ethnic disparities were more variable for the clinical care measures than for the patient experience measures (see Figure 2). But the studies suggest, for example, that we believe black women less when they express symptoms, and we tend to undervalue their pain.”. Our nation and our health care system are grappling with the issue of health equity. Cone Health and other cancer care providers also have worked to address racial disparities in cancer outcomes by encouraging patients of color to obtain regular screenings. If you think that racism is merely people saying mean things to each other and I think it is a system of advantage based on race it will be impossible to co-design any solutions together. This issue of Transforming Care offers examples of health systems that are making efforts to identify implicit bias and structural racism in their organizations, and developing customized approaches to engaging and supporting patients to ameliorate their effects. By Martha Hostetter and Sarah Klein—Sept. Change. As a first step in addressing these disparities, all staff members at the two cancer centers were offered training from the Racial Equity Institute, which included sessions on racial disparities documented in the national cancer registry and the roles of racial bias and gatekeeping in health care. In some cases, the ACCURE navigator worked to overcome patients’ distrust, says Beth Smith, R.N., who serves as Cone Health Cancer Center’s patient navigation program manager. The health system also takes advantage of opportunities to facilitate open discussions about racial bias, as it did in July 2016 after Philando Castile, a local African American man, was shot by a police officer during a traffic stop. Serena Williams’s postpartum complications and the story of Shalon Irving, an epidemiologist at the Centers for Disease Control and Prevention who studied racial disparities in health care and died three weeks after giving birth from complications of high blood pressure, have focused attention on racial disparities in maternal mortality and morbidity (e.g., deaths or complications related to pregnancy and childbirth). Southern Jamaica Plain Health Center convened teen workshops to gain insights about the struggles they face, while Cone Health tapped cancer survivors’ expertise to identify ways the health system didn’t serve them. Ninety-two percent of women who received labor support attended their six-week postpartum appointment, and 89 percent were able to initiate breastfeeding (compared with 79 percent of women nationally). 4 | 2018 National Healthcare Quality and Disparities Report. The first obstacle we find is that organizations don’t have a shared definition of racism, so it is hard to even talk about it. These include: Prioritizing the measurement of health disparities within institutions and among providers. Over the years, HealthPartners has leveraged several different tools to try to decrease the gap, including adding decision support and proactively reaching out to patients. They also examined the experiences of black men or women with early-stage lung cancer, in part to see whether black women’s experiences with breast cancer treatment were related to their gender as much as race. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and set… It’s been 15 years since the publication of the Institute of Medicine’s Unequal Treatment report, which synthesized a wide body of research demonstrating that U.S. racial and ethnic minorities are less likely to receive preventive medical treatments than whites and often receive lower-quality care. NAM found that “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.” By “lower-quality health care,” NAM meant the concrete, inferior care that physicians give their black patients. “I got a flood of e-mails from people of color asking for a list of the doctors,” says Abigail Ortiz, M.S.W., M.P.H., director of community health programs. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Telephone: (301) 427-1364. Health and health care disparities are commonly viewed through the lens of race and ethnicity, but they occur across a broad range of dimensions. Importance Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. Building partnerships to enable patients to play a meaningful role in developing solutions. The goal is to provide high-quality healthcare that is culturally and linguistically sensitive, patient centered, timely, affordable, well coordinated, and safe. They also have worse health outcomes for certain conditions. campaign, which seeks to reduce disparities in blood pressure control by empowering people to monitor their own blood pressure and encouraging others in their networks to do so. After the ACCURE study, treatment completion rates increased among all patients, but they increased more among the intervention group, with 91 percent of black patients and 89 percent of white patients finishing their cancer treatment. Most startling, the analysis found that even after taking into account income, neighborhood, comorbid illnesses, and health insurance type — factors typically invoked to explain racial disparities — health outcomes among blacks, in particular, were still worse than whites. The National Healthcare Quality and Disparities Report assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Even without public reports, health systems can get a sense of disparities from their existing data. Minneapolis-based HealthPartners, which has been stratifying data on its patients’ experiences and outcomes by race and ethnicity for more than a dozen years, found that rates of screening for colorectal cancer among minority patients lagged rates among white patients (in 2009, 43% of patients of color who were candidates for screening completed it vs. 69.2% of white patients). To combat these disparities, advocates say health care professionals must explicitly acknowledge that race and… It also has partnered with the American Heart Association on the national Check. For more information about Mamatoto Village, read our interview with Nedhari. We offer examples of health systems that are making deliberate efforts to identify how implicit bias and structural racism play a role in their work, and developing customized approaches to engaging and supporting patients to ameliorate their effects. Ten years ago, Southern Jamaica Plain Health Center, a Boston primary care clinic associated with Brigham and Women’s Hospital, launched an effort to understand why there were such stark health inequities between white youth and youth of color in their neighborhood. Identifying how these disparities show up in addiction treatment settings, and how to address them, is a critical goal for helping all people with substance abuse struggles achieve recovery. Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. Objectives To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two … In August 2017, the health system sent a home colon cancer screen, known as FIT (fecal immunochemical test), to more than 3,000 patients of color.2 They also encouraged physicians to avoid describing the traditional colonoscopy as the “gold standard” of screening because it implied FIT was inferior when the U.S. Preventive Services Task Force made no distinction. Many of the leading causes of death in the United States—namely heart disease, stroke, and diabetes—disproportionately affect African Americans, Native Americans, and Hispanic Americans, according to the Centers for Disease Control and Prevention (CDC). And while maternal mortality has been dropping in Sub-Saharan Africa, rates actually increased in the United States from 2000 to 2014. This year’s report contains 10 new topics including activity limitations due to chronic diseases, asthma attacks, fatal and nonfatal work-related injuries and illnesses, health-related quality of life, periodontitis in adults, residential proximity to major highwa… In adjusted models, the only remaining disparities in quality of care indicators were HbA1c tests for Hispanics (AOR 0.67, CI = 0.47-0.97), Blacks (AOR 0.59, CI = 0.40-0.88), and Asians (AOR 0.47, CI = 0.42-0.99); foot exams for Hispanics (AOR 0.65, CI = 0.47-0.90); and flu vaccination for Blacks (AOR 0.68, CI = 0.49-0.93). The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings. Nearly 17 years have passed since the Institute of Medicine (IOM) released its landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which summarized the scientific evidence on health disparities at the time. Racial health disparities are a significant barrier to maintaining good health and quality of life for communities of color in the United States. director of community health programs, Southern Jamaica Plain Health Center, Consulting Writer and Editor, Pear Tree Communications, Harkness Fellowships in Health Care Policy and Practice, Association of Health Care Journalists Fellowships, Commonwealth Fund Fellowships in Minority Health, Greensboro Health Disparities Collaborative, Socioeconomic status, education, and other factors, Equity and Structural Racism: Challenges and Opportunities for Healthcare. Instead, Mamatoto has adopted the community health worker (CHW) model, recruiting mothers from the neighborhoods Mamatoto serves and offering them two years of training, mentorship, and field work. Minnesota, which requires health care providers to track racial and ethnic disparities in treatment for a wide range of conditions, has encouraged this by publicly reporting performance on these metrics. After doing ethnographic research that suggested some racial and ethnic minorities were concerned about taking time off work for a colonoscopy and were more likely to respond to a message about treating cancer rather than finding it, Kaiser Permanente created photo novellas (animated comics using photographs) depicting Latino family members trying to convince their loved one to use FIT. Teen births In a review, Moffitt Cancer Center in Tampa, Fla., discovered minorities were unrepresented not only in their clinical trials — a national phenomenon — but as patients. Overview of U.S. Healthcare System Landscape . These findings have led some health care researchers to suggest that the experience of being a black woman in America is, itself, a risk factor — and that attention must be paid both to black women’s level of stress throughout their lives and how they are treated by health care professionals. Use the facilitation guide to work with other health care providers and physicians.Health Disparities ToolkitExplore the AMA's Code of Medical Ethics to answer questions on ethical and professional issue… They also have worse health outcomes for certain conditions. Disparities: Race and Ethnicity, Appendix A.5. Download the Health Disparities Toolkit. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. Importance Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. Black women and men fared the worst with respect to changes in health care access. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. For everyone. So far, four managed care organizations pay for their members to receive Mamatoto’s services. Addressing social factors like unstable housing that can lead to poor health is important, but it’s also necessary to acknowledge past and present policies — redlining, eviction procedures, and disinvestment in low-income communities for example — that fuel housing instability. Black mothers die from pregnancy-related complications at three to four times the rate of white women. 1. Conclusion: Lack of insurance coverage and education explained some of the racial/ethnic … “That was really important to us because it represents real morbidity, real mortality — people dying of strokes and heart attacks that could have been prevented if their blood pressure were controlled,” Wong says. They found that at both cancer centers, black men and women with early-stage breast or lung cancer were less likely to complete treatment than white patients (81% of black patients completed treatment, compared with 87% of white patients), even after taking into account patients’ age, comorbid illnesses, health insurance, income, and marital status. September 27, 2018 Martha Hostetter and Sarah Klein Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. NCHS data on racial and ethnic disparities. In 2003, a group of Greensboro community organizers invited researchers from the University of North Carolina School of Public Health to form the Greensboro Health Disparities Collaborative, an effort to understand and address the lingering effects of segregation. Socioeconomic status, education, and other factors do not appear to protect black women from this risk, while factors including smoking, drug abuse, and obesity do not explain the differences. The group then conducted a study exploring how widespread such experiences were, and whether they affected breast cancer treatment outcomes. Sign up to receive e-alerts and newsletters on the health policy topic you care about most. A recent Institute for Healthcare Improvement white paper called equity “the forgotten aim,” noting as did the 2010 Institute of Medicine report, How Far Have We Come in Reducing Health Disparities?, how little progress has been made. That has helped keep us on track,” say Brian Lloyd, who oversees HealthPartners’ equity initiatives. Objectives To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. Focus group research uncovered concerns among many minority patients about the invasiveness and inconvenience of the traditional colonoscopy. NAM found that “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.” By “lower-quality health care,” NAM meant the concrete, inferior care that physicians give their black patients. Between 2009 and 2017, Kaiser increased the percentage of African Americans whose hypertension was controlled from 75.3 percent to 89.6 percent, bringing the rate within 2.2 percentage points of the rate among white members. For the 16th year in a row, AHRQ is reporting on healthcare quality and disparities. The goal is to provide high-quality healthcare that is culturally and linguistically sensitive, patient centered, timely, affordable, well coordinated, and safe. An official website of the Department of Health and Human Services, Latest available findings on quality of and access to health care, Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects. Agency for Healthcare Research and Quality, Rockville, MD. This exploration, which included convening a group of white and black teens in a racial justice leadership project, led to a number of initiatives, including: offering training for its 100 staff, others at Brigham and Women’s hospital, and community partners to understand the history and current impacts of racism; creating a shared glossary of terms related to racism and other forms of injustice; partnering with nonprofits; and advocating for policy changes to address the root causes of racial health inequities. In 1960, a group of black college students refused to leave a whites-only Woolworth’s lunch counter, coming back day after day. A slide presentation (PPT, 6.8 MB) is also available and can be downloaded free of charge. By Martha Hostetter and Sarah Klein—Sept. 2 Patients identified as speakers of Hmong, Oromo, Somali, Spanish, or Vietnamese received instructions and follow-up calls in their first language. The Electronic Health Record and Health IT to Decrease Racial/Ethnic Disparities in Care. Community members helped develop the research questions, conduct interviews, and analyze the results. Ongoing research is needed to track patterns of health service use and access, especially among vulnerable racial/ethnic and gender groups, to determine whether existing efforts under health care reform reduce long‐standing disparities. Research Article Health Affairs Vol.38 No.7 Racial And Ethnic Disparities In Care Following The New York State Sepsis Initiative The Affordable Care Act (ACA) created new health coverage options that provided an opportunity to narrow longstanding racial and ethnic disparities in health … Do you have any experiences to share along those lines?” says Juan Jaime De Zengotita, M.D., Southern Jamaica Plain’s medical director. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. Confronting Racial Disparities in Health Care: How Providers Can Drive Change: Despite dramatic improvements in the overall health of the population, racial and ethnic disparities in health … To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. Patients were randomly selected and invited to join the ACCURE study and then randomized into intervention and control groups. Compared with whites, members of racial and ethnic minorities are less likely to receive preventive health services and often receive lower-quality care. AHRQ no longer offers print copies of the report, but the files are set up for two-sided color printing and may be downloaded free of charge. Several black women who had survived breast cancer said they had experienced poor treatment, including instances when physicians didn’t take time to explain their diagnoses and options, front-desk staff who treated them with disrespect, and lack of support in dealing with complications. The incident garnered widespread attention and prompted similar protests across the South. However, rates of unmet medical needs due to cost increased without reducing the respective racial/ethnic disparities, and little-to-no change occurred in rates of individuals who have no usual source of care. For As part of the effort, which spanned eight regions, Kaiser Permanente’s clinicians sought to counter misconceptions reported by some black patients that dying from high blood pressure is “natural” by encouraging clinicians to be clear about the risks and dogged in their efforts to encourage patients to come in for treatment. Black women and men fared the worst with respect to changes in health care access. 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