1
|
Kabangu JLK, Fry L, Bhargav AG, De Stefano FA, Bah MG, Hernandez A, Rouse AG, Peterson J, Ebersole K, Camarata PJ, Eden SV. Association of geographical disparities and segregation in regional treatment facilities for Black patients with aneurysmal subarachnoid hemorrhage in the United States. Front Public Health 2024; 12:1341212. [PMID: 38799679 PMCID: PMC11121994 DOI: 10.3389/fpubh.2024.1341212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
Background and objectives This study investigates geographic disparities in aneurysmal subarachnoid hemorrhage (aSAH) care for Black patients and aims to explore the association with segregation in treatment facilities. Understanding these dynamics can guide efforts to improve healthcare outcomes for marginalized populations. Methods This cohort study evaluated regional differences in segregation for Black patients with aSAH and the association with geographic variations in disparities from 2016 to 2020. The National Inpatient Sample (NIS) database was queried for admission data on aSAH. Black patients were compared to White patients. Segregation in treatment facilities was calculated using the dissimilarity (D) index. Using multivariable logistic regression models, the regional disparities in aSAH treatment, functional outcomes, mortality, and end-of-life care between Black and White patients and the association of geographical segregation in treatment facilities was assessed. Results 142,285 Black and White patients were diagnosed with aSAH from 2016 to 2020. The Pacific division (D index = 0.55) had the greatest degree of segregation in treatment facilities, while the South Atlantic (D index = 0.39) had the lowest. Compared to lower segregation, regions with higher levels of segregation (global F test p < 0.001) were associated a lower likelihood of mortality (OR 0.91, 95% CI 0.82-1.00, p = 0.044 vs. OR 0.75, 95% CI 0.68-0.83, p < 0. 001) (p = 0.049), greater likelihood of tracheostomy tube placement (OR 1.45, 95% CI 1.22-1.73, p < 0.001 vs. OR 1.87, 95% CI 1.59-2.21, p < 0.001) (p < 0. 001), and lower likelihood of receiving palliative care (OR 0.88, 95% CI 0.76-0.93, p < 0.001 vs. OR 0.67, 95% CI 0.59-0.77, p < 0.001) (p = 0.029). Conclusion This study demonstrates regional differences in disparities for Black patients with aSAH, particularly in end-of-life care, with varying levels of segregation in regional treatment facilities playing an associated role. The findings underscore the need for targeted interventions and policy changes to address systemic healthcare inequities, reduce segregation, and ensure equitable access to high-quality care for all patients.
Collapse
Affiliation(s)
- Jean-Luc K. Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, KS, United States
| | - Adip G. Bhargav
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Frank A. De Stefano
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Momodou G. Bah
- Michigan State University College of Human Medicine, East Lansing, MI, United States
| | - Amanda Hernandez
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Adam G. Rouse
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Paul J. Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Sonia V. Eden
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN, United States
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, United States
| |
Collapse
|
2
|
Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Racial Disparities at Mixed-Race and Minority Hospitals : Treatment of African American Males With High-Grade Splenic Injuries. Am Surg 2020; 87:287-295. [PMID: 32931304 DOI: 10.1177/0003134820947369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Racial and socioeconomic disparities in health access and outcomes for many conditions is well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American ([AA] vs White) males with high-grade splenic injuries. METHODS Data from the National Trauma Data Bank were utilized from 2007 to 2015; 24 855 AA or White males with high-grade splenic injuries were included. Multilevel mixed-effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS Mortality was significantly higher for AA males at mixed-race (OR 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI, 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2, P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
Collapse
Affiliation(s)
| | - Bradly Watarai
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mark Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
3
|
Tignanelli CJ, Watarai B, Fan Y, Petersen A, Hemmila M, Napolitano L, Jarosek S, Charles A. Racial Disparities at Mixed-Race and Minority Hospitals: Treatment of African American Males With High-Grade Splenic Injuries. Am Surg 2020; 86:441-449. [PMID: 32684029 DOI: 10.1177/0003134820918262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Racial and socioeconomic disparities in health access and outcomes for many conditions are well known. However, for time-sensitive high-acuity diseases such as traumatic injuries, disparities in access and outcomes should be significantly diminished. Our primary objective was to characterize racial disparities across majority, mixed-race, and minority hospitals for African American (AA) versus white males with high-grade splenic injuries. METHODS Data from the National Trauma Data Bank was utilized from 2007 to 2015. A total of 24 855 AA or white males with high-grade splenic injuries were included. Multilevel mixed effects regression analysis was used to evaluate disparities in outcomes and resource allocation. RESULTS Mortality was significantly higher for AA males at mixed-race (odds ratio [OR] 1.6; 95% CI 1.3-2.1; P < .001) and minority (OR 2.1; 95% CI 1.5-3.0; P < .001) hospitals, but not at majority hospitals. At minority hospitals, AA males were significantly less likely to be admitted to the intensive care unit (OR 0.7; 95% CI 0.49-0.97; P = .04) and experienced a significantly longer time to surgery (IRR 1.5; P = .02). Minority hospitals were significantly more likely to have failures from angiographic embolization requiring operative intervention (OR 2.2; P = .009). At both types of nonmajority hospitals, AA males with penetrating injuries were more likely to be managed with angiography (mixed-race hospitals: OR 1.7; P = .046 vs minority hospitals: OR 1.6; P = .08). DISCUSSION While multiple studies have shown that minority hospitals have increased mortality compared to majority hospitals, this study found this disparity only existed for AAs.
Collapse
Affiliation(s)
| | - Bradly Watarai
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Yunhua Fan
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ashley Petersen
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Mark Hemmila
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lena Napolitano
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Affiliation(s)
- Emily A. Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| |
Collapse
|
5
|
Peek ME, Lopez FY, Williams HS, Xu LJ, McNulty MC, Acree ME, Schneider JA. Development of a Conceptual Framework for Understanding Shared Decision making Among African-American LGBT Patients and their Clinicians. J Gen Intern Med 2016; 31:677-87. [PMID: 27008649 PMCID: PMC4870421 DOI: 10.1007/s11606-016-3616-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enhancing patient-centered care and shared decision making (SDM) has become a national priority as a means of engaging patients in their care, improving treatment adherence, and enhancing health outcomes. Relatively little is known about the healthcare experiences or shared decision making among racial/ethnic minorities who also identify as being LGBT. The purpose of this paper is to understand how race, sexual orientation and gender identity can simultaneously influence SDM among African-American LGBT persons, and to propose a model of SDM between such patients and their healthcare providers. METHODS We reviewed key constructs necessary for understanding SDM among African-American LGBT persons, which guided our systematic literature review. Eligible studies for the review included English-language studies of adults (≥ 19 y/o) in North America, with a focus on LGBT persons who were African-American/black (i.e., > 50 % of the study population) or included sub-analyses by sexual orientation/gender identity and race. We searched PubMed, CINAHL, ProQuest Dissertations & Theses, PsycINFO, and Scopus databases using MESH terms and keywords related to shared decision making, communication quality (e.g., trust, bias), African-Americans, and LGBT persons. Additional references were identified by manual reviews of peer-reviewed journals' tables of contents and key papers' references. RESULTS We identified 2298 abstracts, three of which met the inclusion criteria. Of the included studies, one was cross-sectional and two were qualitative; one study involved transgender women (91 % minorities, 65 % of whom were African-Americans), and two involved African-American men who have sex with men (MSM). All of the studies focused on HIV infection. Sexual orientation and gender identity were patient-reported factors that negatively impacted patient/provider relationships and SDM. Engaging in SDM helped some patients overcome normative beliefs about clinical encounters. In this paper, we present a conceptual model for understanding SDM in African-American LGBT persons, wherein multiple systems of social stratification (e.g., race, gender, sexual orientation) influence patient and provider perceptions, behaviors, and shared decision making. DISCUSSION Few studies exist that explore SDM among African-American LGBT persons, and no interventions were identified in our systematic review. Thus, we are unable to draw conclusions about the effect size of SDM among this population on health outcomes. Qualitative work suggests that race, sexual orientation and gender work collectively to enhance perceptions of discrimination and decrease SDM among African-American LGBT persons. More research is needed to obtain a comprehensive understanding of shared decision making and subsequent health outcomes among African-Americans along the entire spectrum of gender and sexual orientation.
Collapse
Affiliation(s)
- Monica E Peek
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA.
- MacLean Center for Clinical Medical Ethics, , The University of Chicago, Chicago, IL, USA.
| | - Fanny Y Lopez
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
- Chicago Center for Diabetes Translation Research, , The University of Chicago, Chicago, IL, USA
| | - H Sharif Williams
- Center for Culture, Sexuality and Spirituality, , Goddard College, Plainfield, VT, USA
- Undergraduate Programs, , Goddard College, Plainfield, VT, USA
| | - Lucy J Xu
- Section of General Internal Medicine, , The University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - M Ellen Acree
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Section of Infectious Diseases, , The University of Chicago, Chicago, IL, USA
- Department of Public Health Sciences, , University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, , University of Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Khera R, Vaughan-Sarrazin M, Rosenthal GE, Girotra S. Racial disparities in outcomes after cardiac surgery: the role of hospital quality. Curr Cardiol Rep 2015; 17:29. [PMID: 25894800 PMCID: PMC4780328 DOI: 10.1007/s11886-015-0587-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Patients from racial and ethnic minorities experience higher mortality after cardiac surgery compared to white patients, both during the early postoperative phase as well as long term. A number of factors likely explain poor outcomes in black and minority patients, which include differences in biology, comorbid health conditions, socioeconomic background, and quality of hospital care. Recent evidence suggests that a major factor underlying excess mortality in these groups is due to their over-representation in low-quality hospitals, where all patients regardless of race have worse outcomes. In this review, we examine the factors underlying racial disparities in outcomes after cardiac surgery, with a primary focus on the role of hospital quality.
Collapse
Affiliation(s)
- Rohan Khera
- Department of Internal Medicine, University of Iowa Hospitals & Clinics, 200 Hawkins Drive, E325 GH, Iowa City, IA, 52242, USA,
| | | | | | | |
Collapse
|
7
|
White K, Haas JS, Williams DR. Elucidating the role of place in health care disparities: the example of racial/ethnic residential segregation. Health Serv Res 2012; 47:1278-99. [PMID: 22515933 PMCID: PMC3417310 DOI: 10.1111/j.1475-6773.2012.01410.x] [Citation(s) in RCA: 213] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To develop a conceptual framework for investigating the role of racial/ethnic residential segregation on health care disparities. DATA SOURCES AND SETTINGS Review of the MEDLINE and the Web of Science databases for articles published from 1998 to 2011. STUDY DESIGN The extant research was evaluated to describe mechanisms that shape health care access, utilization, and quality of preventive, diagnostic, therapeutic, and end-of-life services across the life course. PRINCIPAL FINDINGS The framework describes the influence of racial/ethnic segregation operating through neighborhood-, health care system-, provider-, and individual-level factors. Conceptual and methodological issues arising from limitations of the research and complex relationships between various levels were identified. CONCLUSIONS Increasing evidence indicates that racial/ethnic residential segregation is a key factor driving place-based health care inequalities. Closer attention to address research gaps has implications for advancing and strengthening the literature to better inform effective interventions and policy-based solutions.
Collapse
Affiliation(s)
- Kellee White
- Department of Epidemiology and Biostatistics, University of South Carolina-Arnold School of Public Health, Columbia, SC 29208, USA.
| | | | | |
Collapse
|
8
|
Haider AH, Pronovost PJ. Health information technology and the collection of race, ethnicity, and language data to reduce disparities in quality of care. Jt Comm J Qual Patient Saf 2011; 37:435-6. [PMID: 22013815 DOI: 10.1016/s1553-7250(11)37054-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Adil H Haider
- Division of Trauma and Acute Care Surgery, Johns Hopkins School of Medicine, Baltimore, USA.
| | | |
Collapse
|
9
|
Sarrazin MSV, Campbell ME, Richardson KK, Rosenthal GE. Racial segregation and disparities in health care delivery: conceptual model and empirical assessment. Health Serv Res 2009; 44:1424-44. [PMID: 19467026 PMCID: PMC2739036 DOI: 10.1111/j.1475-6773.2009.00977.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study examines two dimensions of racial segregation across hospitals, using a disease for which substantial disparities have been documented. DATA SOURCES Black (n=32,289) and white (n=244,042) patients 67 years and older admitted for acute myocardial infarction during 2004-2005 in 105 hospital markets were identified from Medicare data. Two measures of segregation were calculated: Dissimilarity (i.e., dissimilar distribution by race across hospitals), and Isolation (i.e., racial isolation within hospitals). For each measure, markets were categorized as having low, medium, or high segregation. STUDY DESIGN The relationship of hospital segregation to residential segregation and other market characteristics was evaluated. Cox proportional hazards regression was used to evaluate disparities in the use of revascularization within 90 days by segregation level. RESULTS Agreement of segregation category based on Dissimilarity and Isolation was poor (kappa=0.12), and the relationship of disparities in revascularization to segregation differed by measure. The hazard of revascularization for black relative to white patients was lowest (i.e., greatest disparity) in markets with low Dissimilarity, but it was unrelated to Isolation. CONCLUSIONS Significant racial segregation across hospitals exists in many U.S. markets, although the magnitude and relationship to disparities depends on definition. Dissimilar distribution of race across hospitals may reflect divergent cultural preferences, social norms, and patient assessments of provider cultural competence, which ultimately impact utilization.
Collapse
Affiliation(s)
- Mary S Vaughan Sarrazin
- Center for Research in Innovative Implementation Strategies for Practice (CRIISP), Iowa City VA Medical Center, Iowa City, Iowa 52246, USA.
| | | | | | | |
Collapse
|
10
|
Waldman HB, Rader R, Perlman SP. Health related issues for individuals with special health care needs. Dent Clin North Am 2009; 53:183-vii. [PMID: 19269390 DOI: 10.1016/j.cden.2008.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
More than 50 million individuals in the United States with developmental disabilities, complex medical problems, significant physical limitations, and a vast array of other conditions considered under the rubric of "disabilities" live in our communities, many as a result of deinstitutionalization and mainstreaming. Children and adults with special health care needs have become a much more integral and visible component of everyday life. This process represents an ongoing change in perceptions about individuals with disabilities and subsequent reform of policies concerning the rights and the principles of care for people with special needs. The reform was built upon an increased role for the family and community health practitioners in providing needed care.
Collapse
Affiliation(s)
- H Barry Waldman
- Department of General Dentistry, School of Dental Medicine, Stony Brook University, Stony Brook, NY 11794-8706, USA.
| | | | | |
Collapse
|
11
|
Sarrazin MV, Campbell M, Rosenthal GE. Racial differences in hospital use after acute myocardial infarction: does residential segregation play a role? Health Aff (Millwood) 2009; 28:w368-78. [PMID: 19258343 DOI: 10.1377/hlthaff.28.2.w368] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study compares the likelihood of admission to high-mortality hospitals for black and white Medicare patients in 118 health care markets, and whether admission patterns vary if residential racial segregation is greater in the area. Risk of admission to high-mortality hospitals was 35 percent higher for blacks than for whites in markets with high residential segregation. Moreover, blacks were more likely than whites to be admitted to hospitals with high mortality, even in analyses limited to patients who lived closest to lower-mortality hospitals. Eliminating health care disparities may require policies that address social factors leading to segregation.
Collapse
|
12
|
Laufman L. Making the invisible visible: professional education to eliminate disparities in clinical trials. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2009; 24:S56-S59. [PMID: 20024829 DOI: 10.1007/bf03182315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
13
|
Smith DB, Feng Z, Fennell ML, Zinn J, Mor V. Racial disparities in access to long-term care: the illusive pursuit of equity. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2008; 33:861-81. [PMID: 18818425 DOI: 10.1215/03616878-2008-022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
While nursing homes were insulated from civil-rights enforcement at the time of the implementation of the Medicare program and lagged behind other parts of the health sector in providing comparable access to minorities, they are the only providers for which current reporting requirements make it possible to fully assess racial disparities in use and quality of care. We find that African Americans' use of nursing homes in 2000 in the United States was 14 percent higher than Caucasians' use. The largest relative African American use of nursing homes in 2000 took place in the South and West. Average nursing-home case-mix acuity for African Americans and Caucasians were essentially identical, suggesting that shifts in payment incentives have eliminated the selective admission of easy-care private-pay (predominantly Caucasian) patients and helped fuel the growth of private pay home care and assisted living for this segment of the population. While these shifts in incentives helped increase the use of nursing homes by African Americans, a high degree of segregation and disparity in the quality of the nursing homes used by African Americans persists. Parity in use is an illusive benchmark for measuring progress in assuring equity in treatment.
Collapse
|
14
|
Davison CM, Edwards N, Webber J, Robinson S. Development of a social justice gauge and its use to review the Canadian Nurses Association's Code of Ethics for Registered Nurses. ANS Adv Nurs Sci 2006; 29:E13-26. [PMID: 17135794 DOI: 10.1097/00012272-200610000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Betty Bekemeier and Patricia Butterfield undertook a critical review of 3 American nursing documents in relation to the concept of social justice. Their article inspired a review of the Canadian Code of Ethics for Registered Nurses, using a Social Justice Gauge developed by the Canadian Nurses Association. The article outlines the development of the gauge and its use in this review. Although some evidence of generic and outdated language is evident in the Canadian code, the text appears well aligned with social justice ideals overall. That being said however, there still remains significant possibility for enlarging the application of social justice, especially in relation to the place of nurses in healthcare institutions and in nontraditional nursing settings, in future revisions of the code. Work to further examine, adapt, and test the Canadian Nurses Association's Social Justice Gauge is encouraged.
Collapse
Affiliation(s)
- Colleen M Davison
- Department of Community Health Sciences, University of Calgary, Alberta, Canada.
| | | | | | | |
Collapse
|
15
|
Cabral ED, Caldas ADF, Cabral HAM. Influence of the patient's race on the dentist's decision to extract or retain a decayed tooth. Community Dent Oral Epidemiol 2006; 33:461-6. [PMID: 16262614 DOI: 10.1111/j.1600-0528.2005.00255.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the influence of the patient's race on the dentist's decision to extract or retain a decayed tooth. METHODS A probabilistic random sample of 297 dentists from Recife, Brazil, was used. Two case scenarios were presented to the dentists. Both scenarios showed a molar that was extensively decayed, but indicated for conservative treatment. The scenarios included a description of the patient and eight photographs of the clinical case, including a photograph of the patient's face. The dentists were asked to regard the patient as poor and then to decide whether to extract or retain the molar. However, although the scenarios were based on the same clinical case, the photographs of the patient's face were different. One scenario showed the photograph of a white patient whereas the other showed the photograph of a black patient. The first scenario was presented 2 months before the second so that the dentists would not remember the former. RESULTS The dentist's decision varied significantly according to the patient's race, with dentists deciding to extract more frequently for the black patient than for the white patient (25.6% vs. 16.2%; P < 0.001). This racial variation occurred regardless of the demographic and socioeconomic variables of the dentists. It did, however, occur as a function of the setting of the dentist's practice. CONCLUSION The patient's race may influence a dentist's decision whether to extract or retain a decayed tooth.
Collapse
Affiliation(s)
- Etenildo Dantas Cabral
- Department of Dental Public Health, Faculty of Dentistry, Pernambuco State University, Camaragibe, Brazil.
| | | | | |
Collapse
|
16
|
Fink BA, Wagner H, Steger-May K, Rosenstiel C, Roediger T, McMahon TT, Gordon MO, Zadnik K. Differences in keratoconus as a function of gender. Am J Ophthalmol 2005; 140:459-68. [PMID: 16083843 DOI: 10.1016/j.ajo.2005.03.078] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 03/30/2005] [Accepted: 03/30/2005] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize gender differences in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. DESIGN Observational, longitudinal study. METHODS A total of 1209 subjects at 16 clinics. For eye-specific categorical variables, the number of eyes per subject with the characteristic was counted. For eye-specific continuous variables, the mean of both eyes was calculated. Multivariate linear (for continuous outcomes) and logistic (for categorical outcomes) regression models were created for each baseline characteristic with statistically significant (P < or = .05) differences between men and women. Age, race, education, and corneal curvature were covariates. RESULTS The women were older, more likely to report a family history of keratoconus, more likely to be nonwhite, and less likely to complete college than men. Vogt's striae and monocular and binocular high-contrast entrance acuity were the only visual characteristics that varied between men and women in the multivariate model. Women were more likely than men to report ocular symptoms of dryness and complaints based upon a composite score of ocular symptoms. Women reported more hours per day of near work and were less likely to report the ability to wear contact lenses for enough hours to permit reading at home in the evening. Women reported more visits to their eye care practitioner during the previous 12 months. NEI-VFQ results revealed differences in self-reported difficulty with distance activities and driving. CONCLUSIONS Gender differences exist in patient history, vision, and ocular symptoms in keratoconus patients.
Collapse
Affiliation(s)
- Barbara A Fink
- The Ohio State University College of Optometry, 338 West Tenth Avenue, Columbus OH 43210-1240, USA
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Murray-García JL, Harrell S, García JA, Gizzi E, Simms-Mackey P. Self-reflection in multicultural training: be careful what you ask for. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:694-701. [PMID: 15980089 DOI: 10.1097/00001888-200507000-00016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Self-reflection in multicultural education is an important means to develop self-awareness and ultimately to change professional behavior in favor of more equitable health care to diverse populations. As conceptualized by scholars in the field of psychology, racial identity theory is critical to understanding and planning for the potentially wide range of predictable reactions to provocative activities, including those negative reactions that do not necessarily herald a flaw in programming. Careful consideration of racial identity developmental phases can also assist program planners to optimally meet the needs of individual physician trainees in their ongoing constructive professional and personal development, and in strategically mobilizing and having ready the type of institutional leadership that supports trainees' change processes. The authors focus on white physician trainees, the largest racial group of U.S. physicians and medical students. They first explain what they mean by the terms white and nonwhite. Racial identity theory is then applied, with true case examples, to explore such issues as where the self-proclaimed "color-blind" trainee fits into this theoretical schema, and how medical educators can best serve trainees who are resistant or indifferent to discussions of racism in medicine and equity in health care delivery. Ultimately, the authors' goal is to demonstrate that engendering genuine self-reflection can substantively improve the delivery of health care to the nation's diverse population. To help achieve that goal, they emphasize what to anticipate in effecting optimal trainee education and how to create an institutional climate supportive of individual change.
Collapse
Affiliation(s)
- Jann L Murray-García
- Center for Health Services Research in Primary Care, University of California, Davis, California, USA
| | | | | | | | | |
Collapse
|
18
|
Wheeler DP. Working with positive men: HIV prevention with black men who have sex with men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2005; 17:102-15. [PMID: 15843121 DOI: 10.1521/aeap.17.2.102.58693] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
There is limited empirical evidence on effective HIV/AIDS prevention for Black MSM. Few studies have been undertaken to examine the specific ways in which Black MSM construct their health and help-seeking practices relative to HIV/AIDS. In this article I examine the role of patients and providers as a collaborative unit to bring about productive HIV/AIDS outcomes. I report on a qualitative study of 50 men who participated in semistructured focus groups and individual interviews. Major themes are presented and discussed: the personal costs of adherence and perceptions about HIV medications and their utility (outcomes), quality of life concerns, impact and importance of the relationship with the primary care provider, elements of the treatment milieu (proximal variables); and personal-historical experiences that shape views of health care and health seeking (antecedent). A sociocultural model of interaction between patient, provider and setting is offered as a framework for working with Black MSM in service delivery and further research.
Collapse
|
19
|
Alkadry MG, Wilson C, Nicholson D. Stroke awareness among rural residents: the case of West Virginia. SOCIAL WORK IN HEALTH CARE 2005; 42:73-92. [PMID: 16390837 DOI: 10.1300/j010v42n02_05] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Stroke is the leading cause of disability and the third leading cause of death in the United States. There are modifiable and non-modifiable stroke risks and proper management of some of these risks could significantly reduce the risk of stroke incidence. However, proper management of stroke risks requires public awareness of these risks and awareness of appropriate approaches to managing them. In case of stroke incidence, it is also important for patients to be able to recognize stroke symptoms and get immediate emergency medical attention. In this article, stroke awareness is studied as awareness of stroke warning signs, proper management of stroke risks, and awareness of what to do in case of stroke. The article analyzes mail questionnaire responses from 1,114 West Virginia residents. Respondents were mostly not properly managing stroke risks such as diabetes and hypertension. There was also a lack of awareness of severe stroke symptoms such as loss of vision in one eye and sudden severe headache. While 83% of respondents reported that they would call 911 if they thought they were having a stroke, only 20% of respondents could correctly identify all stroke warning signs. The study has some limitations, but remains an important study of stroke awareness among rural residents in Appalachia.
Collapse
Affiliation(s)
- Mohamad G Alkadry
- Department of Behavioral Medecine and Psychiatry, West Virginia University School of Medicine, 217 Knapp Hall, Morgantown, WV 26506-6322, USA.
| | | | | |
Collapse
|
20
|
Kunitz SJ, Pesis-Katz I. Mortality of white Americans, African Americans, and Canadians: the causes and consequences for health of welfare state institutions and policies. Milbank Q 2005; 83:5-39. [PMID: 15787952 PMCID: PMC2690387 DOI: 10.1111/j.0887-378x.2005.00334.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The life expectancy of African Americans has been substantially lower than that of white Americans for as long as records are available. The life expectancy of all Americans has been lower than that of all Canadians since the beginning of the 20th century. Until the 1970s this disparity was the result of the low life expectancy of African Americans. Since then, the life expectancy of white Americans has not improved as much as that of all Canadians. This article discusses two issues: racial disparities in the United States, and the difference in life expectancy between all Canadians and white Americans. Each country's political culture and institutions have shaped these differences, especially national health insurance in Canada and its absence in the United States. The American welfare state has contributed to and explains these differences.
Collapse
Affiliation(s)
- Stephen J Kunitz
- Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA.
| | | |
Collapse
|
21
|
Brach C, Fraser I. Reducing disparities through culturally competent health care: an analysis of the business case. Qual Manag Health Care 2002; 10:15-28. [PMID: 12938253 PMCID: PMC5094358 DOI: 10.1097/00019514-200210040-00005] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Finding ways to deliver high-quality health care to an increasingly diverse population is a major challenge for the American health care system. The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. This article reviews the potential role of cultural competence in reducing racial and ethnic health disparities, the strength of health care organizations' current incentives to adopt cultural competence techniques, and the limitations inherent in these incentives that will need to be overcome if cultural competence techniques are to become widely adopted.
Collapse
Affiliation(s)
- Cindy Brach
- Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | | |
Collapse
|
22
|
Schlesinger M. A loss of faith: the sources of reduced political legitimacy for the American medical profession. Milbank Q 2002; 80:185-235. [PMID: 12101871 PMCID: PMC2690108 DOI: 10.1111/1468-0009.t01-1-00010] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The political legitimacy and policymaking influence of the medical profession have greatly declined in American society over the past 30 years. Despite speculation about the causes, there has been little empirical research assessing the different explanations. To address this gap, data collected in 1995 are used to compare attitudes of the American public and policy elites toward medical authority. Statistical analyses reveal that (1) elites are more hostile to professional authority than is the public; (2) the sources of declining legitimacy are different for the public than they are for policy elites; and (3) the perceptions that most threaten the legitimacy of the medical profession pertain to doubts about professional competence, physicians' perceived lack of altruism, and limited confidence in the profession's political influence. This article concludes with some speculations about the future of professional authority in American medicine.
Collapse
Affiliation(s)
- Mark Schlesinger
- Yale University School of Medicine, New Haven, Conn. 06520, USA.
| |
Collapse
|
23
|
Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr 2001; 28:47-58. [PMID: 11579277 DOI: 10.1097/00042560-200109010-00008] [Citation(s) in RCA: 283] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) has resulted in reduced AIDS incidence and mortality. Socially marginalized individuals with HIV infection, particularly injection drug users (IDUs), have received less ART and derived less benefit than others. Little is known about the therapeutic process necessary to promote acceptance of and adherence to ART among marginalized HIV-infected populations. We report on the correlates of both acceptance of and adherence to ART among HIV infected prisoners, most of whom are IDUs. DESIGN Using a cross-sectional survey design within four ambulatory prison HIV clinics, 205 HIV-infected prisoners eligible for ART were recruited between March and October 1996. MEASUREMENTS Detailed interviews were conducted that included personal characteristics, health status and beliefs, and validated standardized scales measuring depression, health locus of control, social desirability and trust in physician, medical institutions and society. Acceptance and adherence were documented by self-report and validated for a subset by pharmacy review. Clinical information was obtained from standardized chart review. Adherence was defined as having taken > or = 80% of ART. RESULTS The acceptance of (80%) and adherence to (84%) ART among this group of prisoners was high. Multiple regression models demonstrated that correlates of acceptance of and adherence to ART differed. Acceptance was associated with trust in physician (8% increase for each unit increase with trust in physician scale) and trust in HIV medications (threefold reduction for those mistrustful of medication). Side effects (OR = 0.09), social isolation (OR = 0.08), and complexity of the antiretroviral regimen (OR = 0.33) were associated with decreased adherence. The prevalence of health beliefs suggesting an adverse relationship between ART and drugs of abuse was high (range 59 to 77%). Adherence did not differ among those receiving directly observed therapy (82%) or self-administration (85%). CONCLUSIONS ART can be successfully administered within a correctional setting. Trust and the therapeutic relationship between patient and physician remain central in the ART initiation process. Characteristics of the therapeutic agents and the degree of social isolation predict adherence. These results may inform the design of interventions to improve both acceptance of and adherence to ART particularly among marginalized populations who have not derived full benefit from these potent new therapies.
Collapse
Affiliation(s)
- F L Altice
- Yale University School of Medicine, New Haven, Connecticut 06510-2483, USA
| | | | | |
Collapse
|
24
|
French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health services utilization and the cost of medical care. Soc Sci Med 2000; 50:1703-13. [PMID: 10798326 DOI: 10.1016/s0277-9536(99)00411-6] [Citation(s) in RCA: 153] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Few studies have examined the relationships between drug use, health services utilization and the cost of medical care for a community-based sample of drug users. The purpose of this study was to analyze recently collected data on chronic drug users (CDUs), CDUs who were also injecting drug users (IDUs) and non-drug users (NDUs) to determine whether these groups exhibited differences in health services utilization and cost. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-reported questionnaire administered to individuals who were recruited through community outreach activities in the USA. Annual differences in health services utilization between CDUs, IDUs and NDUs were estimated for three measures: number of times admitted to a hospital, number of outpatient visits and number of emergency room episodes. Results of this study indicate that CDUs and IDUs consumed significantly more inpatient and emergency care, but less outpatient services relative to NDUs. Analyses of total health care costs showed that CDUs and IDUs each generated about $1000 in excess services utilization per individual relative to NDUs. This research is the first study to compare differences in health services utilization and cost among out-of-treatment drug users relative to a matched group of non-users in a community-based setting. The findings suggest that health care providers and managed care organizations should consider policies that promote more ambulatory care and discourage emergency room and inpatient care among drug users. Innovative and culturally acceptable approaches may be necessary to provide incentives without posing unusual financial hardship.
Collapse
Affiliation(s)
- M T French
- Department of Epidemiology and Public Health, University of Miami School of Medicine, FL 33136, USA.
| | | | | | | |
Collapse
|
25
|
Murray-García JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP. Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care 2000; 38:300-10. [PMID: 10718355 DOI: 10.1097/00005650-200003000-00007] [Citation(s) in RCA: 205] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have investigated the influence of race and/or ethnicity on patients' ratings of quality of care. None have incorporated patients' values and beliefs regarding medical care in assessing these possible differences. OBJECTIVES We explored whether patients' values, ratings, and reports regarding physicians' primary care performance differed by race and/or ethnicity. RESEARCH DESIGN This was a cross-sectional, mailed patient survey. SUBJECTS The study subjects were adult primary care patients in a large health maintenance population (7,747 whites, 836 blacks, 710 Latinos, and 1,007 Asians). MEASURES AND METHODS: Ratings of the following dimensions of primary care were measured: technical competence, communication, accessibility, prevention and health promotion, and overall satisfaction. Patients' values regarding these dimensions and their confidence in medical care were measured. Multivariate analyses yielded associations of race/ethnicity with satisfaction and with reports of prevention services received. RESULTS For 7 of the 10 dimensions of primary care measured, Asians rated physician performance significantly less favorably than did whites, including differences among Asian ethnic subgroups. Latinos rated physicians' accessibility less favorably than did whites. Blacks rated physicians' psychosocial and lifestyle health promotion practices higher than did whites. No differences were found in patient reports of prevention services received, except Pacific Islanders reported receiving significantly more prevention services than whites. CONCLUSIONS In a large HMO population, significant differences were found by race and ethnicity, and among Asian ethnic subgroups, in levels of patient satisfaction with primary care. These findings may represent actual differences in quality of care or variations in patient perceptions, patient expectations, and/or questionnaire response styles. More research is needed to assess, in accurate and culturally appropriate ways, whether health plans are meeting the needs of all enrollees.
Collapse
Affiliation(s)
- J L Murray-García
- Institute for Health Policy Studies, University of California, San Francisco, USA
| | | | | | | | | |
Collapse
|
26
|
Shinagawa SM. The excess burden of breast carcinoma in minority and medically underserved communities: application, research, and redressing institutional racism. Cancer 2000; 88:1217-23. [PMID: 10705358 DOI: 10.1002/(sici)1097-0142(20000301)88:5+<1217::aid-cncr7>3.0.co;2-k] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 1998, the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention reported an overall downward trend in cancer incidence and mortality between 1990 and 1995 for all cancers combined. Many minority and medically underserved populations, however, did not share equally in these improvements. METHODS A review of surveillance and other reports and recent literature on disparities in cancer incidence and mortality in minority and medically underserved communities was conducted 1) to ascertain the extent to which these communities bear an excess cancer burden, and 2) to explore the macrosocietal and microinstitutional barriers to equitable benefits in cancer health care delivery. RESULTS Tragic disparities in cancer incidence and mortality in minority and medically underserved communities continue to be inadequately addressed. Overall improvements in U.S. cancer incidence and mortality rates are not shared equally by all segments of our society. While numerous individual and cultural barriers to optimal cancer control and care exist in minority and medically underserved communities, a major factor precluding these populations from sharing equally in advances in cancer research is prevailing societal and institutional racism. CONCLUSIONS Immediate and equitable application of existing cancer control interventions and quality treatment options will significantly decrease cancer incidence and mortality. Enhanced surveillance efforts and a greater investment in targeted cancer research in those communities with the greatest disparities must be employed immediately if we are to achieve the goal of the president of the United States of eliminating racial and ethnic disparities in cancer and other diseases by 2010. Unless we acknowledge and redress institutionalized racism, the miscarriage of health justice will be perpetuated while celebrated advances in cancer research leading to declining incidence and mortality rates continue to evade our nation's minority and medically underserved communities.
Collapse
Affiliation(s)
- S M Shinagawa
- Chair, Intercultural Cancer Council, Houston, Texas, USA
| |
Collapse
|