Frontiers of Health Services Management - Spring 2014 - (Page 20)

When providers do not understand patients' unique perspectives and values, poor communication can lead to patients' dissatisfaction and distrust (e.g., Schenker et al. 2008); cause patients to misunderstand their illness and treatment plan (Betancourt, Carrillo, and Green 1999); lead to clinical uncertainty and misdiagnosis; and engender overreliance on objective testing, such as CT (computed tomography) scans in the emergency department (e.g., Smedley, Stith, and Nelson 2003). Patient Factors: Mistrust and Lack of Follow-Up Whether a patient accepts and follows through with a provider's recommendations depends on the balance of several key factors, including level of mistrust and cultural beliefs. For example, a survey by the Kaiser Family Foundation (1999) found that 65 percent of African Americans and 58 percent of Hispanics, compared to 22 percent of whites, were afraid of being treated unfairly on the basis of their race and ethnicity when accessing healthcare services. This lack of trust can result in inconsistent care delivery or "doctor shopping," self-medication, and increased demand for referrals and diagnostic tests by patients (Safran et al. 1998). In addition, minority patients who have low general and health literacy are significantly limited in efforts to share in the decision making about and engage in their own care-two major areas that are receiving great attention as part of quality improvement. A Blueprint for Improving Quality and Achieving Equity Just as Crossing the Quality Chasm (Corrigan, Donaldson, and Kohn 2001) serves as a blueprint for action related to improving healthcare quality, Unequal Treatment provides a road map for ensuring healthcare equity by offering a set of recommendations for addressing and eliminating disparities on the basis of race and ethnicity. Interestingly, several of these recommendations can be readily integrated into the quality improvement efforts being designed and implemented today. Moreover, they are synergistic with efforts to improve data collection, measurement, quality, and outcomes. Smedley, Stith, and Nelson (2003) recommend the following steps: 1. All healthcare organizations should collect the race, ethnicity, language preference, and socioeconomic status of all patients to whom they provide care. 2. Demographic data should be linked to quality data, and quality data should be stratified by these demographics to routinely monitor performance and identify disparities in quality of care. 3. Once disparities are identified, quality improvement tactics should be deployed to address and eliminate those disparities. Healthcare organizations may do so by ensuring the broad implementation of evidence-based guidelines and the use of multidisciplinary teams and community outreach. 4. To support this work, all healthcare professionals should be trained in (a) the root causes of disparities, (b) the impact of patient race and ethnicity on clinical decision making, and (c) cultural competence-or cross-cultural communication-so that they can communicate with and provide high-quality care to diverse populations. 2 0 * f ro ntier s o f h ea lt h s e r vic e s ma na g e m e nt 30 :3

Table of Contents for the Digital Edition of Frontiers of Health Services Management - Spring 2014

Frontiers of Health Services Management - Spring 2014
Contents
Editorial
Baylor Health Care System’s Journey to Provide Equitable Care
In Pursuit of High-Value Healthcare: The Case for Improving Quality and Acheiving Equity in a Time of Healthcare Transformation
Ending Healthcare Disparities: An Urgent Priority and a Growing Possibility
Expanding the Evidence Base for Health Equity
A Historical Perspective on Disparities as Context for Our Work Ahead

Frontiers of Health Services Management - Spring 2014