高血压英文ppt精品课件health disparities from knowledge to

Health Disparities From knowledge to action,Overview of Disparities,Overview of Disparities,Minority Americans report widespread patient-physician communication differences Minority Americans are more likely to feel treated with disrespect when obtaining health care Though the gap is closing disparities persist in satisfaction with primary and secondary care,Overview of Disparities,From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care IOM 2003,Overview of Disparities,Minority Americans have worse health status and more chronic conditions Minority Americans have lower rates of insurances coverage and less access to care,Overview of Disparities,Disparities are found across a range of clinical settings, including public and private hospitals, teaching and non-teaching hospitals, etc. Disparities in care are associated with higher mortality among minorities (e.g., Bach et al., 1999; Peterson et al., 1997; Bennett et al., 1995),Overview of Disparities,Disparities consistently found across a wide range of disease areas and clinical services Disparities are found even when clinical factors, such as stage of disease presentation, co-morbidities, age, and severity of disease are taken into account,Potential sources of healthcare disparities,Health systems-level factors financing, structure of care; cultural and linguistic barriers. Patient-level factors including patient preferences, refusal of treatment, poor adherence, biological differences. Disparities arising from the clinical encounter.,Causes of Death (2000) USA,Mortality Rates* (All causes) 2000,From National Center for Health Statistics * - rates reported per 100,000 individuals,Cardiovascular/Cerebrovascular,Leading cause of death in African American men (33.5%) and women (40.6%) More than twice as likely to die from hypertensive heart disease Prevalence of high blood pressure one of the highest in the world ( worse in the southeastern US) 45% have blood cholesterol levels of 200 mg/dl,36%of African Americans have hypertension African Americans at greater risk than whites for death from both Two to three times greater risk to have an ischemic stroke Higher death rates from stroke Americans,Diabetes,2.7 million or 11.4% of all African Americans more than twenty years old have DM. African Americans and Hispanics are twice as likely to have DM than non-Hispanic whites. There is twice the risk of developing heart disease and stroke. 2 to 4 times the risk of dying from heart disease. One in every four African American women over 55 years has DM.,HIV/AIDS,Problem of EPIDEMIC proportion. African Americans accounted for half of the new cases in 2001. More than 168,000 African Americans died of AIDS in 2001. Leading cause of death in African American men aged 35-44. Approximately 78% of HIV infected women are minorities. African-American and Hispanic children accounted for more than 80% of pediatric AIDS cases in 2000.,Aids Infection by Gender and Race,Females,Males,64%,17%,17%,43%,35%,20%,Cancer Death Rates, by Race and Ethnicity, 1996-2000,*Per 100,000, age-adjusted to the 2000 US standard population. Hispanic is not mutually exclusive from whites, African Americans, Asian/Pacific Islanders, and American Indians. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.,All sites 356.2 249.5 1.4 Larynx 5.7 2.4 2.4 Prostate 73.0 30.2 2.4 Stomach 14.0 6.1 2.3 Myeloma 9.2 4.5 2.0 Oral cavity and pharynx 7.9 4.0 2.0 Esophagus 12.2 7.3 1.7 Liver 9.3 6.0 1.6 Lung & bronchus 107.0 78.1 1.4 Pancreas 16.4 12.0 1.4 Small intestine 0.7 0.5 1.4 Colon & rectum 34.6 25.3 1.4,Cancer Sites in Which African-American Death Rates Exceed White Death Rates for Men, US, 1996-2000,*Per 100,000, age-adjusted to the 2000 US standard population. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.,Site,African American,White,Ratio of African American/White,Cancer Survival*(%) by Site and Race,1992-1999,*5-year relative survival rates based on cancer patients diagnosed from 1992 to 1999 and followed through 2000. Source: Surveillance, Epidemiology, and End Results Program, 1975-2000, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.,All Sites 64 53 11 Breast (female) 88 74 14 Colon & rectum 63 53 10 Esophagus 15 9 6 Leukemia 48 39 9 Non-Hodgkin lymphoma 57 47 10 Oral cavity 60 36 24 Prostate 99 93 6 Urinary bladder 83 64 19 Uterine cervix 73 61 12 Uterine corpus 86 60 26,Site,White,% Difference,African American,Causes of Death in African Americans (2000) - Georgia,Health Status in Georgia,Disparities in Georgia,Outcomes in Georgia Infant mortality rates in African Americans is more than twice that in Whites. Prostate Cancer death rates are 50% higher in African Americans. African Americans are more than twice as likely to die from Hypertensive Heart Disease. Hispanics are twice as likely to die from Diabetes than whites.,From: Georgia Division of Public Health; Vital Statistics 2001,Disparities in Georgia,Coverage in Georgia More likely to use emergency room as main source of medical care. 4 to 5 times less likely to have had BP check in last 2yrs. 3 to 4 times less likely to have had a mammogram in last 2yrs. Children 2 times less likely to have seen a doctor in last 2 years.,Uninsured by Ethnicity (2002) - GA.,11%,6.8%,20.3%,13.8%,From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003),Uninsured by Ethnicity (2002) - USA,18.2%,10.7%,20.2%,32.4%,Uninsured by race and income,From : Georgia Healthcare Coverage Project ( Custer & Ketsche 2003),I.O.M Report,“In unassailable terms, the report found that even when their insurance and income are the same as those of whites, minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments, including heart disease, cancer, diabetes and HIV/AIDS. By stripping away the pretense that the differences can be explained by minorities lack of access to timely care, the report should spur doctors and patients to question why racial disparities are tolerated in medicine.” USA Today, March 22 “Racial Bias in Health Care”,I.O.M. Recommendations,Policy & Regulatory Avoid fragmentation of health plans along socioeconomic lines. Strengthen the stability of patient-provider relationships in publicly funded health plans. Increase the proportion of under-represented US racial and ethnic minorities among health professionals.,From : Unequal Treatment; Confronting Racial and Ethnic Disparities in Health care IOM 2003,I.O.M. Recommendations,Policy & Regulatory Apply the same managed care protections to publicly funded HMO enrollees that apply to private HMO enrollees. Provide greater resources for the DHHS Office for Civil Rights to enforce civil rights laws.,From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care IOM 2003,I.O.M. Recommendations,Health Systems Promote the consistency and equity of care through use of evidence based guidelines. Structure payment systems to ensure adequate supply of services to minority patients and limit provider incentives that promote disparities. Enhance patient-provider communications and trust by providing financial incentives for practices that decrease barriers and encourage evidence based practices.,From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care IOM 2003,I.O.M. Recommendations,Health System Support the use of interpretation services where community need exists. Support the use of community health workers Implement multi-disciplinary treatment and preventive care teams.,From : Unequal treatment; Confronting Racial and Ethnic Disparities in Health care IOM 2003,I.O.M. Recommendations,Education Implement patient edu