Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
J Am Coll Radiol ; 16(4 Pt B): 547-553, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30947886

RESUMO

The US health care system is in the midst of incredible transformation. High-value, high-quality health care is the ultimate goal. Guided by the Institute of Medicine report "Crossing the Quality Chasm," the focus is to deliver care that is safe, efficient, effective, timely, patient centered, and equitable. Equity is the principle that quality of care should not vary based on patient characteristics, such as race or ethnicity. Even with the same insurance and socioeconomic status and when comorbidities, stage of presentation, and other confounders are controlled for, minorities often receive a lower quality of health care than their white counterparts. These racial and ethnic disparities in quality of care contribute to disparities in health outcomes and higher costs. Radiology is not exempt from this issue, as disparities related to imaging services have been reported in the literature. The root causes of racial and ethnic disparities in health care are complex and include the negative impact of the social determinants of health, limited access to care, as well as health system, provider, and patient factors. The field of radiology has a unique opportunity to engage in efforts to improve quality, address disparities, and achieve equity. A call to action is necessary, with a focus on addressing social determinants of health; creating culturally, linguistically, and health literacy-appropriate outreach and services; investing in cross-cultural education; and diversifying the radiology workforce. Ultimately, radiologists can provide equitable access to radiology care and promote person-centered care solutions that are tailored to the needs of diverse populations.


Assuntos
Assistência à Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Radiologia/economia , Radiologia/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Defesa do Paciente , Fatores Socioeconômicos , Estados Unidos
3.
BMC Pediatr ; 18(1): 18, 2018 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-29385988

RESUMO

BACKGROUND: By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting. METHODS: A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus. RESULTS: Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation. CONCLUSIONS: There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.


Assuntos
Coleta de Dados/métodos , Equidade em Saúde , Disparidades em Assistência à Saúde , Pediatria , Canadá , Grupos de Populações Continentais , Avaliação da Deficiência , Registros Eletrônicos de Saúde , Grupos Étnicos , Identidade de Gênero , Humanos , Idioma , Grupos Minoritários , Comportamento Sexual , Determinantes Sociais da Saúde , Estados Unidos
4.
Health Aff (Millwood) ; 36(6): 1095-1101, 2017 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-28583969

RESUMO

Leaders of health care organizations need to be prepared to improve quality and achieve equity in today's health care environment characterized by a focus on achieving value and addressing disparities in a diverse population. To help address this need, the Disparities Solutions Center at Massachusetts General Hospital launched the Disparities Leadership Program in 2007. The leadership program is an ongoing, year-long, executive education initiative that trains leaders from hospitals, health plans, and health centers to improve quality and eliminate racial and ethnic disparities in health care. Feedback from participating organizations demonstrates that health care leaders seem to possess knowledge about what disparities are and about what should be done to eliminate them. Data collection, performance measurement, and multifaceted interventions remain the tools of the trade. However, the barriers to success are lack of leadership buy-in, organizational prioritization, energy, and execution, which can be addressed through organizational change management strategies.


Assuntos
Equidade em Saúde , Disparidades em Assistência à Saúde , Liderança , Inovação Organizacional , Grupos de Populações Continentais , Grupos Étnicos , Acesso aos Serviços de Saúde , Humanos , Massachusetts , Pesquisa Qualitativa
5.
JMIR Mhealth Uhealth ; 5(4): e54, 2017 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-28438728

RESUMO

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a disease affecting approximately 29.1 million people in the United States, and an additional 86 million adults have prediabetes. Diabetes self-management education, a complex health intervention composed of 7 behaviors, is effective at improving self-care behaviors and glycemic control. Studies have employed text messages for education, reminders, and motivational messaging that can serve as "cues to action," aiming to improve glucose monitoring, self-care behaviors, appointment attendance, and medication adherence. OBJECTIVES: The Text to Move (TTM) study was a 6-month 2-parallel group randomized controlled trial of individuals with T2DM to increase physical activity, measured by a pedometer. The intervention arm received text messages twice daily for 6 months that were tailored to the participant's stage of behavior change as defined by the transtheoretical model of behavior change. METHODS: We assessed participants' attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audiorecorded, transcribed verbatim, coded, and analyzed using a grounded theory approach. RESULTS: The response rate was 67% (31/46 participants). The average age was 51.4 years and 61% (19/31 participants) were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of the participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their health care center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. CONCLUSIONS: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT01569243; http://clinicaltrials.gov/ct2/show/NCT01569243 (Archived by Webcite at http://www.webcitation.org/6pfH6yXag).

6.
J Diabetes Complications ; 30(3): 554-60, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26774790

RESUMO

Latinos are at increased risk for obesity and type 2 diabetes (T2D). Well-designed information technology (IT) interventions have been shown to be generally efficacious in improving diabetes self-management. However, there are very few published IT intervention studies focused on Latinos. With the documented close of the digital divide, Latinos stand to benefit from such advances. There are limited studies on how best to address the unique socio-cultural-linguistic characteristics that would optimize adoption, use and benefit among Latinos. Successful e-health programs involve frequent communication, bidirectionality including feedback, and multimodal delivery of the intervention. The use of community health workers (CHWs) has been shown consistently to improve T2D outcomes in Latinos. Incorporating CHWs into eHealth interventions is likely to address barriers with technology literacy and improve patient activation, satisfaction and adherence. Additionally, tailored interventions are more successful in improving patient activation. It is important to note that tailoring is more than linguistic translation; tailoring interventions to the Latino population will need to address educational, language, literacy and acculturation levels, along with unique illness beliefs and attitudes about T2D found among Latinos. Interventions will need to go beyond the lone participant and include shared decision making models that incorporate family members and friends.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/terapia , Disparidades nos Níveis de Saúde , Hispano-Americanos , Telemedicina/métodos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Autocuidado/métodos , Resultado do Tratamento
7.
BMC Pediatr ; 15: 187, 2015 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-26577820

RESUMO

BACKGROUND: Transgender (TG) individuals experience discordance between their sex at birth and their gender identity. To better understand the health care needs and characteristics of TG youth that contribute to resilience, we conducted a qualitative study with clinical and non-clinical providers. METHODS: In-depth interviews were conducted of providers (n = 11) of TG youth (ages 13-21). Convenience and purposive sampling were used to recruit participants in the Boston area. All interviews were audio-recorded and transcribed verbatim. An interview guide of 14 open-ended questions was used to guide the discussion. A grounded theory approach was utilized to code and analyze the data, including double-coding to address issues of inter-rater reliability. RESULTS: Five primary themes emerged: 1) resilience of TG youth 2) lack of access to services that influence health, 3) the critical role of social support, 4) challenges in navigating the health care system, and 5) the need for trans-affirming competency training for providers and frontline staff. CONCLUSION: The findings of this study show that providers recognize multiple barriers and challenges in the care of TG youth. However, they also identify the resilience exhibited by many youth. We propose that providers can further enhance the resilience of TG youth and help them flourish by offering them necessary resources via the creation of safe and welcoming clinical environments.


Assuntos
Identidade de Gênero , Pessoal de Saúde , Serviços de Saúde para Pessoas Transgênero/normas , Disparidades em Assistência à Saúde/normas , Relações Profissional-Paciente , Pesquisa Qualitativa , Pessoas Transgênero/psicologia , Adolescente , Boston , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Reprodutibilidade dos Testes , Apoio Social , Adulto Jovem
8.
Int J Health Policy Manag ; 2(2): 91-4, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24639984

RESUMO

The article by Cheri Wilson, "Patient Safety and Healthcare Quality: The Case for Language Access", highlights the challenges of providing Culturally and Linguistically Appropriate Services (CLAS) to patients with Limited English Proficiency (LEP). As the US pursues high-value, high-performance healthcare, our ability to meet the needs of our most vulnerable will determine whether we succeed or fail in the long run. With the implementation of the Affordable Care Act (ACA), this is more important than ever before, as it is estimated that the newly insured are more likely to be minority and less likely to speak English than their currently insured counterparts. As such, we must create a safe, high-quality healthcare system for all, especially in this time of incredible healthcare transformation and unprecedented diversity. Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals provides a blueprint for achieving this goal, and Massachusetts General Hospital (MGH) is taking action.

9.
J Healthc Qual ; 36(3): 5-16, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24629098

RESUMO

Since the 1999 Institute of Medicine (IOM) report To Err is Human, progress has been made in patient safety, but few efforts have focused on safety in patients with limited English proficiency (LEP). This article describes the development, content, and testing of two new evidence-based Agency for Healthcare Research and Quality (AHRQ) tools for LEP patient safety. In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them. Based on our findings, Improving Patient Safety Systems for Limited English Proficient Patients: A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process. The Hospital Guide was validated with leaders in quality and safety at diverse hospitals, and the TeamSTEPPS LEP module was field-tested in varied settings within three hospitals. Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention.


Assuntos
Barreiras de Comunicação , Idioma , Erros Médicos/prevenção & controle , Corpo Clínico Hospitalar/educação , Segurança do Paciente/normas , Melhoria de Qualidade , Tradução , Humanos , Estados Unidos , United States Agency for Healthcare Research and Quality
10.
Jt Comm J Qual Patient Saf ; 37(10): 437-45, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22013816

RESUMO

BACKGROUND: Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions. There has been an acceleration of health information technology (HIT) implementation in the United States, with health care reform legislation including multiple provisions for collecting and using health information to improve and monitor quality and efficiency in health care. Despite an uneven and generally low level of implementation, research has demonstrated that HIT has the potential to improve quality of care and patient safety. If carefully designed and implemented, HIT also has the potential to eliminate disparities. HIT AND DISPARITIES: Several root causes for disparities are amenable to interventions using HIT, particularly innovations in electronic health records, as well as strategies for chronic disease management. Recommendations regardinghealth care system, provider, and patient factors can help health care organizations address disparities as they adopt, expand, and tailor their HIT systems. In terms of health care system factors, organizations should (1) automate and standardize the collection of race/ethnicity and language data, (2) prioritize the use of the data for identifying disparities and tailoring improvement efforts, (3) focus HIT efforts to address fragmented care delivery for racial/ethnic minorities and limited-English-proficiency patients, (4) develop focused computerized clinical decision support systems for clinical areas with significant disparities, and (5) include input from racial/ethnic minorities and those with limited English proficiency in developing patient HIT tools to address the digital divide. CONCLUSIONS: As investments are made in HIT, consideration must be given to the impact that these innovations have on the quality and cost of health care for all patients, including those who experience disparities.


Assuntos
Grupos de Populações Continentais , Grupos Étnicos , Disparidades em Assistência à Saúde/organização & administração , Sistemas de Informação/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Competência Cultural , Coleta de Dados/métodos , Sistemas de Apoio a Decisões Clínicas/organização & administração , Disparidades em Assistência à Saúde/etnologia , Humanos , Idioma , Sistemas Computadorizados de Registros Médicos/organização & administração , Autocuidado/métodos , Confiança
11.
Jt Comm J Qual Patient Saf ; 36(10): 435-42, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21548504

RESUMO

UNLABELLED: INEQUALITY IN QUALITY: Disparities in health care and quality for racial, ethnic, linguistic, and other disadvantaged groups are widespread and persistent. Health care organizations are engaged in efforts to improve quality in general but often make little attempt to address disparities. STANDARD VERSUS CULTURALLY COMPETENT QUALITY IMPROVEMENT (QI): Most QI interventions are broadly targeted to the general population-a "one-size-fits-all" approach. These standard QI efforts may preferentially improve quality for more advantaged patients and maintain or even worsen existing disparities. Culturally competent QI interventions place specific emphasis on addressing the unique needs of minority groups and the root causes of disparities. HOW QI CAN REDUCE DISPARITIES: QI interventions can reduce disparities in at least three ways: (1) In some cases, standard QI interventions can improve quality more for those with the lowest quality, but this is unreliable; (2) group-targeted QI interventions can reduce disparities by preferentially targeting disparity groups; and (3) culturally competent QI interventions, by tailoring care to cultural and linguistic barriers that cause disparities, can improve care for everyone but especially for disparity groups. GUIDELINES FOR CULTURALLY COMPETENT QI: A culturally competent approach to QI should (1) identify disparities and use disparities data to guide and monitor interventions, (2) address barriers unique to specific disparity groups, and (3) address barriers common to many disparity group. CONCLUSIONS: To achieve equity in health care, hospitals and other health care organizations should move toward culturally competent QI and disparities-targeted QI interventions to achieve equity in health care, a key pillar of quality.


Assuntos
Assistência à Saúde/normas , Disparidades em Assistência à Saúde , Melhoria de Qualidade/normas , Grupos de Populações Continentais , Competência Cultural , Acesso aos Serviços de Saúde , Humanos , Área Carente de Assistência Médica
12.
Milbank Q ; 86(2): 241-72, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18522613

RESUMO

CONTEXT: Racial and ethnic disparities in health care in the United States have been well documented, with research largely focusing on describing the problem rather than identifying the best practices or proven strategies to address it. METHODS: In 2006, the Disparities Solutions Center convened a one-and-a-half-day Strategy Forum composed of twenty experts from the fields of racial/ethnic disparities in health care, quality improvement, implementation research, and organizational excellence, with the goal of deciding on innovative action items and adoption strategies to address disparities. The forum used the Results Based Facilitation model, and several key recommendations emerged. FINDINGS: The forum's participants concluded that to identify and effectively address racial/ethnic disparities in health care, health care organizations should: (1) collect race and ethnicity data on patients or enrollees in a routine and standardized fashion; (2) implement tools to measure and monitor for disparities in care; (3) develop quality improvement strategies to address disparities; (4) secure the support of leadership; (5) use incentives to address disparities; and (6) create a message and communication strategy for these efforts. This article also discusses these recommendations in the context of both current efforts to address racial and ethnic disparities in health care and barriers to progress. CONCLUSIONS: The Strategy Forum's participants concluded that health care organizations needed a multifaceted plan of action to address racial and ethnic disparities in health care. Although the ideas offered are not necessarily new, the discussion of their practical development and implementation should make them more useful.


Assuntos
Barreiras de Comunicação , Grupos Étnicos , Reforma dos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/classificação , Qualidade da Assistência à Saúde/organização & administração , Coleta de Dados/métodos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...