Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper

Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper The purpose of this assignment is for you to demonstrate your awareness of disparities in health care experienced by some ethnic and cultural populations, as well as your understanding of culturally competent strategies for addressing those challenges. PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper Create a visually interesting and well organized 6-panel brochure (you may use a Word template as a starting point) that could be used as an informative handout to assist health care professionals in providing culturally competent care to a disadvantaged patient population. Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper In your brochure: List some reasons why specific patient cultural populations face challenges when it comes to receiving competent care. Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper Identify strategies that can be used to overcome those challenges. Include professional resources that could be used by healthcare providers to learn more about disadvantaged patient groups and how to become more culturally competent when treating them. Briefly describe why each resource would be helpful. Assignment: Disparities in Health Care Ethnic and Cultural Populations Paper You are encouraged to include graphics in your brochure. Provide citations in standard format on the last panel of the brochure for any sources where you find information or images. Remember that this brochure is for professionals in a health care setting—both the information and look of the brochure should be geared to this audience. Points Possible: 25 7 points for overall look, layout, visual appeal 15 points for content as outlined above 3 points for writing level (LEVEL 1) level_1___writing.jpg toolkit.pdf addressing_ethnic_and_cultural_disparities_in_health_care.pdf Multicultural Health Care: A Quality Improvement Guide This guide is brought to you by NCQA and Eli Lilly and Company. MG48754 1107 PRINTED IN USA. ©2007, ELI LILLY AND COMPANY. ALL RIGHTS RESERVED. Multicultural Health Care: A Quality Improvement Guide was developed by the National Committee for Quality Assurance (NCQA) in collaboration with Eli Lilly and Company. In late 2006, NCQA and Eli Lilly and Company began discussions about developing a comprehensive quality improvement guide and toolkit to help health care organizations as they seek to provide culturally and linguistically appropriate services and reduce health care disparities in the populations they serve. Without Lilly’s substantive support, and in particular, the direction provided by Dr. Kathleen Shoemaker, the publication of this guide would not have been possible. We would like to recognize the following individuals for their contribution to the Guide: Jessica Briefer French, Diane Schiff, Esther Han and Robin Weinick for composing the text; Annie Chiu and Jayaram Chelluri for their involvement in the collection and analysis of examples gathered for inclusion in the accompanying DVD; Judy Lacourciere, Gerald Stewart, Ledia Tabor and Jeff Van Ness for their continuous support and review of all materials and text; Patty Salmerón and Lori Fox for creative design and layout; Sarah Hudson Scholle, Kathi Mudd, Greg Pawlson and Phyllis Torda for their leadership and support on this project. We would like to recognize the important contributions of the Multicultural Health Care Quality Improvement Guide Expert Panel, who provided guidance and support in the development and creation of this Guide. None of the members of the Expert Panel received compensation for their services. Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers – through medicines and information – for some of the world’s most urgent medical needs. Additional information about Lilly is available at www.lilly.com. NCQA is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. Planning • Rita Carreón – Senior Manager Clinical Strategies, America’s Health Insurance Plans Introduction Acknowledgements Assessment Multicultural Health Care: A Quality Improvement Guide • Marshall H. Chin, MD, MPH – Associate Professor of Medicine, University of Chicago • Robert Like, MD, MS – Professor and Director, The Center for Healthy Families and Cultural Diversity, UMDNJ Robert Wood Johnson Medical School • Elizabeth Lowy, RN, BSN – QM Manager, Health Care Equality, National Quality Management, Aetna, Inc. •PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper Rick MacCornack, PhD – Chief Systems Integration Officer, Northwest Physicians Network • Cheryl McMahill–Walraven, MSW – Informatics Manager, Integrated Care Analysis Team, Aetna Health Analytics Implementation • Karen Kraemer, RN, CMC – Senior Director of Case Management, HealthPartners • Marsha Regenstein, PhD – Associate Research Professor, Department of Health Policy, George Washington University Medical Center • Marissa Schlaifer – Pharmacy Affairs Director, Academy of Managed Care Pharmacies • Vincenza Snow, MD, FACP – Director, Clinical Programs and Quality of Care, American College of Physicians Evaluation • David Nerenz, PhD – Senior Staff Investigator, Center for Health Services Research, Henry Ford Health System • Nicole Van Borkulo, Med – NVB Consulting, Inc. National Initiative for Children’s Healthcare Quality (NICHQ) Conclusion • Ellen Wu – Executive Director, The California Pan-Ethnic Health Network Introduction Assessment Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 2 Chapter 2: Planning . . . . . . . . . . . . . . . . . . . . . . . . . . p. 19 Chapter 3: Implementation . . . . . . . . . . . . . . . . . . . . p. 31 Planning Chapter 1: Assessment . . . . . . . . . . . . . . . . . . . . . . . p. 9 Chapter 4: Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . p. 41 Conclusion Evaluation Implementation Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . p. 54 Introduction Introduction Multicultural Health Care: A Quality Improvement Guide In an earlier work, Crossing the Quality Chasm,2 the IOM established equity as one of the six integral components of quality health care — so it follows that reducing disparities is essential to any quality improvement (QI) effort. According to the Office of Minority Health (OMH), culture has a particularly strong influence in how care is administered, in part because different cultures often define health and disease differently and have different beliefs about the human body, illness and health care. These disparities are associated with worse outcomes, and must be eliminated in order to provide equitable care.1 Resources for sharing knowledge and experiences of organizations that have already done this work are limited. This publication will serve as a starting point for some organizations and as a bank of resources for others who already have experience in pursuing QI initiatives to improve CLAS. Improvements in cultural and linguistic competency contribute to enhanced communication and understanding among patients and providers, and to improved quality of care for culturally, ethnically and linguistically diverse patients. While there is limited evidence on the types of interventions needed to reduce racial and ethnic disparities in quality,3-9 generic QI efforts and interventions that address cultural and language needs have both been successful; thus, there is value in combining our knowledge and efforts in quality with those of culturally and linguistically appropriate services (CLAS). Multicultural Health Care: A Quality Improvement Guide (“the Guide”) was created to provide a QI framework for health care organizations seeking to promote more culturally appropriate care, provide equitable access for individuals with limited English proficiency and reduce health care disparities.PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper The Guide applies to a variety of organizations, including managed care organizations (MCO), public health organizations, community clinics, disease management (DM) organizations, hospitals and other organizations that arrange for or deliver health care services. The accompanying DVD offers a collection of ready-to-use tools that have been used successfully in other health care settings, along with several comprehensive reference documents. Many health care organizations have used QI initiatives to improve the quality of clinical care they deliver to patients.10 A significant gap remains, however, in the quality of care that racial and ethnic minorities receive — especially when compared to the quality of care that White patients receive.1,11,12 In recent years, many organizations have begun to use the basic tenets of QI to tackle this gap in the quality of care they provide. Thus, Culturally and Linguistically Appropriate Services (CLAS): “Health care services that are respectful of and responsive to cultural and linguistic needs.”1 Health Care Organization: A public or private institution involved in any aspect of delivering or financing and arranging for health care services. Health Care Disparity: “A difference in treatment provided to members of different racial or ethnic groups that is not justified by the underlying health conditions or treatment preferences of patients.”2 Health Disparity: “Differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups in the United States.”3 Provider: An institution or organization that provides health care services. Examples of providers include hospitals, clinics and home health agencies.4 Planning While there is widespread agreement that reducing disparities in health care is important, until recently, organizations have found little guidance on developing culturally and linguistically competent programs and few models of tested and successful approaches to reducing disparities.3-9 Practitioner: A professional who provides health care services and is usually required to be licensed as defined by law.4 Quality Improvement (QI): In this guide, includes any change in an organization’s design, programmatic offerings, benefits, delivery system structure, and administrative or clinical processes designed to improve health care quality or customer experiences, including efforts that specifically address cultural or linguistic competence and focus on reducing disparities in health care. REFERENCES 1 U.S. Department of Health and Human Services Office of Minority Health, National Standards for Culturally and Linguistically Appropriate Services in Health Care: Final Report. Washington, DC March, 2001. Available at: http://www.omhrc.gov/assets/pdf/checked/finalreport.pdf. Accessed October 4, 2007. 2 Institute of Medicine of the National Academies. Smedley, Stith, and Nelson Eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press. 2003 Implementation About this Guide Cultural and Linguistic Competence: “Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. ‘Culture’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper Competence’ implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”1 Evaluation while there are many factors that affect health, research suggests that improving cultural competence and language access can reduce poor health outcomes and enhance quality of care. Culturally appropriate services may also contribute to reduced disparities.13 The Institute of Medicine’s (IOM) landmark 2003 study, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,1 showed that racial and ethnic disparities in care exist across a wide range of health conditions and health care services. The report also showed that most disparities remain, even when controlling socioeconomic status and other access-related factors. Assessment TERMS AND DEFINITIONS 3 National Institutes of Health. Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities, Volume 1, Fiscal Years 2002-2006. Available at: http://ncmhd.nih.gov/our_programs/strategic/pubs/volumeI_031003EDrev.pdf. Accessed October 16, 2007. 2 2 3 Conclusion 4 The National Committee for Quality Assurance, Standards for the Accreditation of MCOs© 2005. Washington, DC, 2005. Introduction How to Use This Guide The leadership and staff of many health care organizations recognize the inherent value of meeting the cultural and linguistic needs of their diverse patient populations. According to a 2007 Alliance of Community Health Plans (ACHP) report, Making the Business Case for Culturally and Linguistically Appropriate Services in Care: Case Studies from the Field,18 “Many organizations that have engaged in or implemented CLAS standards…are doing so because they believe it is the right thing to do, and not because they are required to do so by law or regulation. Organizations with a history of meeting the needs of diverse patient populations view their role in addressing the needs of all patients they serve as an important part of their organizational culture.” Multicultural Health Care: A Quality Improvement Guide is organized into four chapters that follow the steps of a basic QI process. 1. Assessment 2. Planning 3. Implementation 4. Evaluation Each chapter contains explanatory text, information on following the process and examples from a variety of settings. The accompanying DVD contains tools, resources and reference materials. References to specific materials in the text are highlighted by this icon. Most materials can be downloaded directly from the DVD; others View the attached are on Web sites, in e-learning DVD of successful QI courses or in other interactive programs and tools. tools available only on-line. QI teams and other individuals committed to improving care for diverse populations will undoubtedly appreciate the importance of an organization that supports their efforts — not 2 4 Within the Planning and Implementation phases of the process, the Guide encourages the use of small tests of change in which the QI team plans and implements initiatives on a small scale or implements smaller components of a larger initiative, in order to evaluate them and Esther S. Han, MPH Annie W. Chiu REFERENCES 1 Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC. National Academy Press; 2003. Planning Where business-level rationale is needed, there is evidence that pursuing cultural competence can bring a noticeable return on an organization’s investment. For example, the ACHP report states that health plans providing CLAS have achieved increased enrollment and market share among the insured. According to the report, “cultural competency attracts business,” and leads to reduced cost of interpretation services and length of hospital stay and increased patient and provider satisfaction. PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper While the Guide promotes small tests of change and the practice of breaking larger changes or projects into smaller components for testing before moving forward, it is important not to lose sight of the larger goal. Whatever the initiative, the organization should not forget why it is doing this work, what it hopes to change and who the changes will affect. As the QI team moves forward, it should continue to assess its progress and ensure that with every change, the initiative is doing what it is intended to do — taking the organization one step closer to improved health care for its diverse population. Implementation The support of senior leadership for CLAS and disparities initiatives is essential to their success. Organizations whose leadership supports efforts to improve cultural competence and language access and reduce disparities will certainly appreciate the benefits of this support. For organizations without such backing, making the case for implementing QI initiatives to improve care for diverse populations will be crucial in attempting meaningful change. The argument for this work can be based on legal regulatory compliance,14-17 good business practices or even on moral grounds. make necessary modifications before moving forward with the next small test. Small tests can be implemented until all potential problems or unintended consequences are identified and can help reduce the risks that come along with changes or new programs in any organization. Refer to Chapter 2 and Chapter 3 for a more detailed discussion of small tests. The Guide refers to those who are carrying out these activities as the “QI team.” QI Teams generally include representatives with different knowledge, skills, experiences and perspectives, often from different departments or divisions within an organization and even from the community or external stakeholders that are affected by the problems targeted or the changes proposed. QI Teams are especially helpful when the process or system in question is complex or cross-functional, when no one person in the organization knows all the dimensions of an issue or when the process involves more than one discipline or area of operation, as is often the case. The collective contributions of the various individuals that make up the QI team can be a source of cooperation and creativity and may be valuable when seeking leadership and organization-wide support.19 2 Institute of Medicine, Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC. National Academy Press, 2001. 3 Chin, Walters, Cook, Huang, Interventions to Reduce Racial and Ethnic Disparities in Health Care. Medical Care Research and Review, Vol 64; Suppl, 2007. 4 Davis, Vinci, Okwuosa, Chase, Huang, Cardiovascular Health Disparities: A Systematic Review of Health Care Interventions. Medical Care Research and Review, Vol 64; 29 Suppl, 2007. 5 Peek, Cargill, Huang, Diabetes Health Disparities: A Systematic Review of Health Care Interventions. Medical Care Research and Review, Vol 64; 101 Suppl, 2007. PMI SOC 325 Disparities in Health Care Ethnic and Cultural Populations Paper Evaluation There are hurdles to effectively tackling cultural competence, language access and disparities reduction. In addition to financial and other business challenges, there may be several organization-specific barriers, not the least of which is scarcity of leadership and organizational support that may stem from a lack of understanding of the issues and opposition to change. only through support of specific projects or initiatives, but also by creating an organizational culture that stresses equitable care and cultural and linguistic competence as goals for staff and leadership alike. Differences in health care quality and outcomes have been shown to result from differences in the culture of health care organizations, and differences in culture may also be responsible for different degrees of improvement in the provision of culturally competent and equitable care.7 6 Van Voorhees, Walters, Prochaska, Quinn, Reducing Health Disparities in Depressive Disorders Outcomes between Non-Hispanic Whites and Ethnic Minorities: A Call for Pragmatic Strategies over the Life Course. Medical Care Research and Review, Vol 64; 157 Suppl, 2007. 7 Masi, Blackman, Peek, Interventions to Enhance Breast Cancer Screening, Diagnosis, and Treatment among Racial and Ethnic Minority Women. Medical Care Research and Review, Vol 64; 195 Suppl, 2007. 2 5 Conclusion Making the Case for CLAS Assessment Multicultural Health Care: A Quality Improvement Guide Introduction Multicultural Health Care: A Quality Improvement Guide 8 Fisher, Burnet, Huang, Chin, Cagney, Cultural Leverage: Interventions Using Culture to Narrow Racial Disparities in Health Care. Medical Care Research and Review, Vol 64; 243 Suppl, 2007. NOTES 9 Chien, Chin, Davis, Casalino, Pay for Performance, Public Reporting and Racial Disparities in Health Care: How are Programs Being Designed? Medical Care Research and Review, Vol 64; 283 Suppl, 2007. Assessment 10 National Committee for Quality Assurance. Recognizing Innovation in Multicultural Health Care. Washington, DC, 2006. Available at http://web.ncqa.org/Portals/0/HEDISQM/CLAS/CLAS_InnovativePrac06.pdf. 11 National Healthcare Disparities Report, 2006. Full Report. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nhdr06/report/. Accessed October 6, 2007. 12 Chou, Brown, Jensen, Shih, Pawlson, Hudson Scholle, Gender and Racial Disparities in the Management of Diabetes Mellitus among Medicare Patients. Women’s Health Issues. 2007 May-Jun;17(3):150-61. 13 Kilbourne et al. Advancing Health Disparities Research Within the Health Care System: A Conceptual Framework. American Journal of Public Health. December 2006, Vol 96, No. 12. 14 Executi … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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