高血压英文ppt精品课件addressing disparity in health and health care for racial and ethnic

Columbus Health Department Addressing Disparity in Health and Health Care for Racial and Ethnic Minorities: An Internal Assessment Health Service Delivery Carla Hayden, R.N.,M.B.A , Director, Office Of Minority Health Michelle L. Groux, M.P.H, Epidemiologist, Office of Assessment and Surveillance Manisha H. Maskay, Ph.D., Director, Division of Planning & Preparedness Columbus Health Department The Context and . . . the Mandate Disparities in health status, health care and health outcomes: exist are unacceptable, and must be eliminated! Columbus Health Department The journey to eliminate disparities n Is an ongoing process not a discrete event n Requires collaboration from many partners n Must be evaluated regularly to assure progress assess impact identify gaps, strengths & opportunities celebrate successes Columbus Health Department Health Care Racism Housing Employment / SES Education Racial and Ethnic Health Disparity Circles of Influence Individual Racial/Ethnic Health Disparity Columbus Health Department Sadly, health disparities have existed for far too long n Racial and ethnic health disparities have been documented for over a century. n In the early 1900s, Dr. Booker T. Washington, along with other African American leaders, noted poorer health status for African Americans as well as a link between health status and social and economic well-being. Columbus Health Department Racial & Ethnic Health Disparities - Columbus n As in other U.S. urban areas - disparities in health status and outcomes are persistent & in some cases are increasing: Infant mortality Low birth weight Diabetes prevalence & mortality Sexually transmitted diseases Columbus Health Department Mortality per 100,000 African American Caucasian All Causes of Death 1,212 927 Heart Disease 319 261 Cancer 264 218 Stroke 89 66 Prostate Cancer 85 26 Diabetes 76 29 Hypertension/hypertensive renal disease 22 5 Homicide 19 4 Infant Mortality (deaths per 1,000 live births) 15 7 HIV disease 10 3 Source: ODH, Vital Statistics 99-01(Deaths and Births) 2002 Franklin County Health Assessment (Behavior data) Health Disparities Columbus Columbus Health Department Health Issues African American Caucasian New cases per 100,000 Syphilis 19 1 Prevalence % of population Overweight (adult) 68 55 High Blood Pressure (adult) 37 26 Food insecurity (adult ) 12 5 Diabetes (adult) 9 6 Inadequate Prenatal Care (live births) 21 11 Birth weight of less than 5.5 lbs (live births) 12 7 Teen Births-mom less than 18 ( live births) 6 2 Source: ODH, Vital Statistics 99-01(Deaths and Births) 2002 Franklin County Health Assessment (Behavior data) Health Disparities Columbus Columbus Health Department Racial Disparities Columbus Infant Mortality Rates IMR* Ratio Difference in IMR = increase of 1.7% a year * Infant Mortality Ratio Columbus Health Department Moving forward: Early 1900s 2002 Dr. Booker T. Washington IOM Columbus Health Department In 1999, Congress commissioned an Institute of Medicine study to assess differences in type and quality of healthcare received by minority and non -minority populations. Moving Forward: Columbus Health Department Relevant findings : Racial and ethnic disparities in health care exist . . . They are associated with worse outcomes in many cases and are therefore unacceptable They occur in the context of: - broader historic & contemporary social & economic inequality - evidence of persistent racial & ethnic discrimination in many sectors Many sources may contribute: - health systems - health care providers - patients - utilization managers The IOM Report UNEQUAL TREATMENT: Confronting Racial and Ethnic Disparities in Health Care Columbus Health Department Addressing the problem Our Efforts Office of Minority Health established - 2000 Key accomplishments: Provided cultural competency education for all staff in 2001 Developed Interpretation/Translation Service Provide ongoing training to clinical staff on how to work with interpreters Provide ongoing educational programs on diversity, cultural issues and addressing disparity Columbus Health Department Addressing the problem Our Efforts Challenges: Increasing needs/decreasing resources Ensuring cultural competency education for new staff Assuring cultural competency of all staff on an ongoing basis Identifying and addressing problem areas Ongoing evaluation process & outcomes Columbus Health Department Addressing the problem Our Efforts Internal Assessment of Columbus Health Department to: - develop a sustainable effort to assess and improve upon the Columbus Health Departments work related to addressing racial and ethnic health disparities. Columbus Health Department Addressing the problem Our Efforts Leadership Vision/Mission Staff Composition Policies & Procedures Service Delivery Staff Development & Training Performance Standards Outcomes Management Performance Evaluation Collaborations Organizational components to be considered in an internal assessment include: Columbus Health Department Addressing the problem Our Efforts Internal Assessment Phases: I. Health Service Delivery II. Community Health Assessment and Surveillance Activities III. Organizational Cultural Competency Columbus Health Department Objectives: Determine how programs assess the specific needs of racial and ethnic minorities in order to provide the most appropriate care Determine how programs address needs of racial and ethnic minorities Assess strengths and weaknesses in addressing racial and ethnic disparities Identify gaps and opportunities Service Delivery Assessment Columbus Health Department Service Delivery Assessment Methods: n Development of Assessment Tool Reviewed research/practice literature for existing instruments Designed tool to assess direct service programs efforts to address racial & ethnic health disparities: n Demographic information collected n Communication and outreach efforts n Services provided n Outcomes measured n Gaps related to addressing needs of minorities n Opportunities for organizational support Columbus Health Department Methods: Pilot Conducted with two programs to assess functionality & inter-interviewer reliability Program Interviews Conducted between July and September 2003 one hour in length with managers of direct service programs 21 programs Service Delivery Assessment Columbus Health Department Key Findings - Of 21 programs interviewed: 60% provided “enhanced or specific services focused toward racial and ethnic minority populations” 86% collected data on client race/ethnicity - primarily through self report 24% collected information on clients country of birth 29% collected data on primary language of clients 86% collected outcome data - 17% of these considered outcomes by race 67% reported that staff had received diversity or cultural education in the past year Service Delivery Assessment Columbus Health Department Challenges: n Personnel and time resources n Program staff “buy in” need to clearly communicate that assessment process is to improve services & understand client needs vs. monitoring program performance n Competing needs balancing requirements of external funders with those of the health department Service Delivery Assessment Columbus Health Department Findings Moving from data to solutions to Eliminate Racial and Ethnic Health Disparities Solutions Service Delivery Assessment Columbus Health Department Data Collection Collect standard socioeconomic data Maintain data electronically Outcome Analysis Analyze outcome data by race and ethnicity Service Delivery Assessment: Recommendations and Solutions Columbus Health Department Service Delivery Assessment: Recommendations and Solutions Develop and implement “Guidelines for the Collection of Race and Ethnicity Data,” by Columbus Health Department Clinics and Programs Implement Medical Manager Electronic Records System Columbus Health Department Provide services in a culturally and linguistically appropriate manner Implement Federal “Culturally and Linguistically Appropriate Services in Health Care” CLAS Standards - Federal Register: December 22, 2000, Volume 65, Number 247, page 80865-80879 Service Delivery Assessment: Recommendations and Solutions Columbus Health Department Culturally and Linguistically Appropriate Services in Health Care (CLAS) “The standards for culturally and linguistically appropriate services proposed as a means to correct inequities that currently exist in the provision of health services and to make these services more responsive to the individual needs of all patients/customers.” Source: Culturally and Lingu