addressing disparity in health and health care for - citymatch课件

AddressingDisparityinHealthandHealthCareforRacialandEthnicMinorities AnInternalAssessment HealthServiceDelivery CarlaHayden R N M B A Director OfficeOfMinorityHealthMichelleL Groux M P H Epidemiologist OfficeofAssessmentandSurveillanceManishaH Maskay Ph D Director DivisionofPlanning Preparedness TheContextand theMandate Disparitiesinhealthstatus healthcareandhealthoutcomes existareunacceptable andmustbeeliminated Thejourneytoeliminatedisparities Isanongoingprocess notadiscreteeventRequirescollaborationfrommanypartnersMustbeevaluatedregularlytoassureprogressassessimpactidentifygaps strengths opportunitiescelebratesuccesses RacialandEthnicHealthDisparityCirclesofInfluence IndividualRacial EthnicHealthDisparity Sadly healthdisparitieshaveexistedforfartoolong Racialandethnichealthdisparitieshavebeendocumentedforoveracentury Intheearly1900 s Dr BookerT Washington alongwithotherAfricanAmericanleaders notedpoorerhealthstatusforAfricanAmericansaswellasalinkbetweenhealthstatusandsocialandeconomicwell being Racial EthnicHealthDisparities Columbus AsinotherU S urbanareas disparitiesinhealthstatusandoutcomesarepersistent insomecasesareincreasing InfantmortalityLowbirthweightDiabetesprevalence mortalitySexuallytransmitteddiseases Mortality per100 000AfricanAmericanCaucasianAllCausesofDeath1 212927HeartDisease319261Cancer264218Stroke8966ProstateCancer8526Diabetes7629Hypertension hypertensiverenaldisease225Homicide194InfantMortality deathsper1 000livebirths 157HIVdisease103 Source ODH VitalStatistics 99 01 DeathsandBirths 2002FranklinCountyHealthAssessment Behaviordata HealthDisparitiesColumbus HealthIssuesAfricanAmericanCaucasianNewcasesper100 000Syphilis191Prevalence ofpopulationOverweight adult 6855HighBloodPressure adult 3726Foodinsecurity adult 125Diabetes adult 96InadequatePrenatalCare livebirths 2111Birthweightoflessthan5 5lbs livebirths 127TeenBirths momlessthan18 livebirths 62 Source ODH VitalStatistics 99 01 DeathsandBirths 2002FranklinCountyHealthAssessment Behaviordata HealthDisparitiesColumbus RacialDisparitiesColumbusInfantMortalityRates IMR Ratio DifferenceinIMR increaseof1 7 ayear InfantMortalityRatio Movingforward Early1900s2002Dr BookerT WashingtonIOM In1999 CongresscommissionedanInstituteofMedicinestudytoassessdifferencesintypeandqualityofhealthcarereceivedbyminorityandnon minoritypopulations MovingForward Relevantfindings Racialandethnicdisparitiesinhealthcareexist Theyareassociatedwithworseoutcomesinmanycases andarethereforeunacceptable Theyoccurinthecontextof broaderhistoric contemporarysocial economicinequality evidenceofpersistentracial ethnicdiscriminationinmanysectors Manysourcesmaycontribute healthsystems healthcareproviders patients utilizationmanagers TheIOMReportUNEQUALTREATMENT ConfrontingRacialandEthnicDisparitiesinHealthCare Addressingtheproblem OurEfforts OfficeofMinorityHealthestablished 2000Keyaccomplishments Providedculturalcompetencyeducationforallstaffin2001DevelopedInterpretation TranslationServiceProvideongoingtrainingtoclinicalstaffonhowtoworkwithinterpretersProvideongoingeducationalprogramsondiversity culturalissuesandaddressingdisparity Addressingtheproblem OurEfforts Challenges Increasingneeds decreasingresourcesEnsuringculturalcompetencyeducationfornewstaffAssuringculturalcompetencyofallstaffonanongoingbasisIdentifyingandaddressingproblemareasOngoingevaluation process outcomes Addressingtheproblem OurEfforts InternalAssessmentofColumbusHealthDepartmentto developasustainableefforttoassessandimproveupontheColumbusHealthDepartment sworkrelatedtoaddressingracialandethnichealthdisparities Addressingtheproblem OurEfforts LeadershipVision MissionStaffCompositionPolicies ProceduresServiceDeliveryStaffDevelopment Training PerformanceStandardsOutcomesManagementPerformanceEvaluationCollaborations Organizationalcomponentstobeconsideredinaninternalassessmentinclude Addressingtheproblem OurEfforts InternalAssessmentPhases I HealthServiceDeliveryII CommunityHealthAssessmentandSurveillanceActivitiesIII OrganizationalCulturalCompetency Objectives DeterminehowprogramsassessthespecificneedsofracialandethnicminoritiesinordertoprovidethemostappropriatecareDeterminehowprogramsaddressneedsofracialandethnicminoritiesAssessstrengthsandweaknessesinaddressingracialandethnicdisparitiesIdentifygapsandopportunities ServiceDeliveryAssessment ServiceDeliveryAssessment Methods DevelopmentofAssessmentToolReviewedresearch practiceliteratureforexistinginstrumentsDesignedtooltoassessdirectserviceprograms effortstoaddressracial ethnichealthdisparities DemographicinformationcollectedCommunicationandoutreacheffortsServicesprovidedOutcomesmeasuredGapsrelatedtoaddressingneedsofminoritiesOpportunitiesfororganizationalsupport Methods PilotConductedwithtwoprogramstoassessfunctionality inter interviewerreliabilityProgramInterviewsConductedbetweenJulyandSeptember2003onehourinlengthwithmanagersofdirectserviceprograms21programs ServiceDeliveryAssessment KeyFindings Of21programsinterviewed 60 provided enhancedorspecificservicesfocusedtowardracialandethnicminoritypopulations 86 collecteddataonclientrace ethnicity primarilythroughselfreport24 collectedinformationonclients countryofbirth29 collecteddataonprimarylanguageofclients86 collectedoutcomedata 17 oftheseconsideredoutcomesbyrace67 reportedthatstaffhadreceiveddiversityorculturaleducationinthepastyear ServiceDeliveryAssessment Challenges PersonnelandtimeresourcesProgramstaff buyin needtoclearlycommunicatethatassessmentprocessistoimproveservices understandclientneedsvs monitoringprogramperformanceCompetingneedsbalancingrequirementsofexternalfunderswiththoseofthehealthdepartment ServiceDeliveryAssessment Findings MovingfromdatatosolutionstoEliminateRacialandEthnicHealthDisparities Solutions ServiceDeliveryAssessment DataCollectionCollectstandardsocioeconomicdataMaintaindataelectronicallyOutcomeAnalysisAnalyzeoutcomedatabyraceandethnicity ServiceDeliveryAssessment RecommendationsandSolutions ServiceDeliveryAssessment RecommendationsandSolutions Developandimplement GuidelinesfortheCollectionofRaceandEthnicityData byColumbusHealthDepartmentClinicsandProgramsImplementMedicalManagerElectronicRecordsSystem ProvideservicesinaculturallyandlinguisticallyappropriatemannerImplementFederal CulturallyandLinguisticallyAppropriateServicesinHealthCare CLASStandardsFederalRegister December22 2000 Volume65 Number247 page80865 80879 ServiceDeliveryAssessment RecommendationsandSolutions CulturallyandLinguisticallyAppropriateServicesinHealthCare CLAS Thestandardsforculturallyandlinguisticallyappropriateservices proposedasameanstocorrectinequitiesthatcurrentlyexistintheprovisionofhealthservicesandtomaketheseservicesmoreresponsivetotheindividualneedsofallpatients customers Source Cultura