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Lin SC, Hammond G, Esposito M, Majewski C, Foraker RE, Joynt Maddox KE. Segregated Patterns of Hospital Care Delivery and Health Outcomes. JAMA HEALTH FORUM 2023; 4:e234172. [PMID: 37991783 PMCID: PMC10665978 DOI: 10.1001/jamahealthforum.2023.4172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/29/2023] [Indexed: 11/23/2023] Open
Abstract
Importance Residential segregation has been shown to be a root cause of racial inequities in health outcomes, yet little is known about current patterns of racial segregation in where patients receive hospital care or whether hospital segregation is associated with health outcomes. Filling this knowledge gap is critical to implementing policies that improve racial equity in health care. Objective To characterize contemporary patterns of racial segregation in hospital care delivery, identify market-level correlates, and determine the association between hospital segregation and health outcomes. Design, Setting, and Participants This cross-sectional study of US hospital referral regions (HRRs) used 2018 Medicare claims, American Community Survey, and Agency for Healthcare Research and Quality Social Determinants of Health data. Hospitalization patterns for all non-Hispanic Black or non-Hispanic White Medicare fee-for-service beneficiaries with at least 1 inpatient hospitalization in an eligible hospital were evaluated for hospital segregation and associated health outcomes at the HRR level. The data analysis was performed between August 10, 2022, and September 6, 2023. Exposures Dissimilarity index and isolation index for HRRs. Main Outcomes and Measures Health outcomes were measured using Prevention Quality Indicator (PQI) acute and chronic composites per 100 000 Medicare beneficiaries, and total deaths related to heart disease and stroke per 100 000 residents were calculated for individuals aged 74 years or younger. Correlation coefficients were used to compare residential and hospital dissimilarity and residential and hospital isolation. Linear regression was used to examine the association between hospital segregation and health outcomes. Results This study included 280 HRRs containing data for 4386 short-term acute care and critical access hospitals. Black and White patients tended to receive care at different hospitals, with a mean (SD) dissimilarity index of 23 (11) and mean (SD) isolation index of 13 (13), indicating substantial variation in segregation across HRRs. Hospital segregation was correlated with residential segregation (correlation coefficients, 0.58 and 0.90 for dissimilarity and isolation, respectively). For Black patients, a 1-SD increase in the hospital isolation index was associated with 204 (95% CI, 154-254) more acute PQI hospitalizations per 100 000 Medicare beneficiaries (28% increase from the median), 684 (95% CI, 488-880) more chronic PQI hospitalizations per 100 000 Medicare beneficiaries (15% increase), and 6 (95% CI, 2-9) additional deaths per 100 000 residents (6% increase) compared with 68 (95% CI, 24-113; 6% increase), 202 (95% CI, 131-274; 8% increase), and 2 (95% CI, 0 to 4; 3% increase), respectively, for White patients. Conclusions and Relevance This cross-sectional study found that higher segregation of hospital care was associated with poorer health outcomes for both Black and White Medicare beneficiaries, with significantly greater negative health outcomes for Black populations, supporting racial segregation as a root cause of health disparities. Policymakers and clinical leaders could address this important public health issue through payment reform efforts and expansion of health insurance coverage, in addition to supporting upstream efforts to reduce racial segregation in hospital care and residential settings.
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Affiliation(s)
- Sunny C. Lin
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics, Washington University in St Louis, St Louis, Missouri
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri
| | - Gmerice Hammond
- Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | - Cassandra Majewski
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Randi E. Foraker
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri
- Institute for Informatics, Washington University in St Louis, St Louis, Missouri
| | - Karen E. Joynt Maddox
- Institute for Public Health, Washington University in St Louis, St Louis, Missouri
- Cardiovascular Division, Washington University School of Medicine in St Louis, St Louis, Missouri
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Clark SG, Cohen A, Heard-Garris N. Moving Beyond Words: Leveraging Financial Resources to Improve Diversity, Equity, and Inclusion in Academic Medical Centers. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09914-4. [PMID: 36495346 PMCID: PMC9739343 DOI: 10.1007/s10880-022-09914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
Abstract
Diversity, equity, and inclusion (DEI) efforts at academic medical centers (AMCs) began prior to 2020, but have been accelerated after the death of George Floyd, leading many AMCs to recommit their support for DEI. Institutions crafted statements to decry racism, but we assert that institutions must make a transparent, continuous, and robust financial investment to truly show their commitment to DEI. This financial investment should focus on (1) advocacy efforts for programs that will contribute to DEI in health, (2) pipeline programs to support and guide minoritized students to enter health professions, and (3) the recruitment and retention of minoritized faculty. While financial investments will not eliminate all DEI concerns within AMCs, investing significant financial resources consistently and intentionally will better position AMCs to truly advance diversity, equity, and inclusion within healthcare, the community, and beyond.
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Affiliation(s)
- Shawnese Gilpin Clark
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Avenue, Box 162, Chicago, IL 60611 USA
| | - Alyssa Cohen
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Nia Heard-Garris
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL USA ,Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E Chicago Avenue, Box 162, Chicago, IL 60611 USA ,Division of Advanced General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
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Eberth JM, Hung P, Benavidez GA, Probst JC, Zahnd WE, McNatt MK, Toussaint E, Merrell MA, Crouch E, Oyesode OJ, Yell N. The Problem Of The Color Line: Spatial Access To Hospital Services For Minoritized Racial And Ethnic Groups. Health Aff (Millwood) 2022; 41:237-246. [PMID: 35130071 DOI: 10.1377/hlthaff.2021.01409] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric-distance-to investigate access to care on a national scale.
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Affiliation(s)
- Jan M Eberth
- Jan M. Eberth , University of South Carolina, Columbia, South Carolina
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Muigai W. Framing Black Infant and Maternal Mortality. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:85-91. [PMID: 35244000 DOI: 10.1017/jme.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This article looks to the past to consider how government officials, health professionals, and legal authorities have historically framed racial disparities in birth and the lasting impact these explanations have had on Black birthing experiences and outcomes.
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Wilkins CH, Williams M, Kaur K, DeBaun MR. Academic Medicine's Journey Toward Racial Equity Must Be Grounded in History: Recommendations for Becoming an Antiracist Academic Medical Center. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1507-1512. [PMID: 34432719 PMCID: PMC8542070 DOI: 10.1097/acm.0000000000004374] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The harsh realities of racial inequities related to COVID-19 and civil unrest following police killings of unarmed Black men and women in the United States in 2020 heightened awareness of racial injustices around the world. Racism is deeply embedded in academic medicine, yet the nobility of medicine and nursing has helped health care professionals distance themselves from racism. Vanderbilt University Medical Center (VUMC), like many U.S. academic medical centers, affirmed its commitment to racial equity in summer 2020. A Racial Equity Task Force was charged with identifying barriers to achieving racial equity at the medical center and medical school and recommending key actions to rectify long-standing racial inequities. The task force, composed of students, staff, and faculty, produced more than 60 recommendations, and its work brought to light critical areas that need to be addressed in academic medicine broadly. To dismantle structural racism, academic medicine must: (1) confront medicine's racist past, which has embedded racial inequities in the U.S. health care system; (2) develop and require health care professionals to possess core competencies in the health impacts of structural racism; (3) recognize race as a sociocultural and political construct, and commit to debiologizing its use; (4) invest in benefits and resources for health care workers in lower-paid roles, in which racial and ethnic minorities are often overrepresented; and (5) commit to antiracism at all levels, including changing institutional policies, starting at the executive leadership level with a vision, metrics, and accountability.
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Affiliation(s)
- Consuelo H. Wilkins
- C.H. Wilkins is senior vice president and senior associate dean for health equity and inclusive excellence, Office of Health Equity, and professor of medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mamie Williams
- M. Williams is senior director of nurse diversity, equity, and inclusion, Nursing Administration, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karampreet Kaur
- K. Kaur is a first-year resident, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. At the time of writing, the author was a fourth-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael R. DeBaun
- M.R. DeBaun is professor of pediatrics and medicine, J.C. Peterson Endowed Chair in Pediatrics, Department of Pediatrics, and director, Vanderbilt-Meharry Sickle Cell Disease Center of Excellence, Vanderbilt University Medical Center, Nashville, Tennessee
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Hess JJ, Salas RN. Invited Perspective: Life Cycle Analysis: A Potentially Transformative Tool for Lowering Health Care's Carbon Footprint. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:71302. [PMID: 34251876 PMCID: PMC8312472 DOI: 10.1289/ehp9630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Jeremy J. Hess
- Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
- Center for Health and the Global Environment, University of Washington, Seattle, Washington, USA
| | - Renee N. Salas
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts, USA
- Center for Climate, Health, and the Global Environment (C-CHANGE), Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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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
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Abstract
United States' courts have played a limited, yet key, role in shaping health equity in three areas of law: racial discrimination, disability discrimination, and constitutional rights. Executive and administrative action has been much more instrumental than judicial decisions in advancing racial equality in health care. Courts have been reluctant to intervene on racial justice because overt discrimination has largely disappeared, and the Supreme Court has interpreted civil rights laws in a fashion that restricts judicial authority to address more subtle or diffused forms of disparate impact. In contrast, courts have been more active in limiting disability discrimination by expanding the conditions that are considered disabling and by articulating and applying the operative concepts "reasonable accommodation" and "other qualified" in the context of both treatment and insurance coverage decisions. Finally, regarding constitutional rights, courts have had limited opportunity to intervene because, outside of specially protected arenas such as reproduction, constitutional law gives government wide discretion to define health and safety goals and methods. Thus, courts have had only a limited role in shaping health equity in the United States. It remains to be seen whether this will change under the Affordable Care Act or whatever health reform measure might replace it.
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James SA. The strangest of all encounters: racial and ethnic discrimination in US health care. CAD SAUDE PUBLICA 2017; 33Suppl 1:e00104416. [PMID: 28492707 DOI: 10.1590/0102-311x00104416] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022] Open
Abstract
In 2003, a Committee of the Institute of Medicine of the National Academy of Sciences summarized hundreds of studies documenting that US racial minorities, especially African Americans, receive poorer quality health care for a wide variety of conditions than their White counterparts. These racial differences in health care persist after controlling for sociodemographic factors and patients' ability to pay for care. The Committee concluded that physicians' unconscious negative stereotypes of African Americans, and perhaps other people of color, likely contribute to these health care disparities. This paper selectively reviews studies published after 2003 on the likely contribution of physicians' unconscious bias to US health care disparities. All studies used the Implicit Association Test which quantifies the relative speed with which individuals associate positive attributes like "intelligent" with Whites compared to Blacks or Latino/as. In addition to assessing physicians' unconscious attitudes toward patients, some studies focused on the behavioral and affective dimensions of doctor-patient communication, such as physicians' "verbal dominance" and whether patients felt respected. Studies reviewed found a "pro-white" unconscious bias in physicians' attitudes toward and interactions with patients, though some evidence suggests that Black and female physicians may be less prone to such bias. Limited social contact between White physicians and racial/ethnic minorities outside of medical settings, plus severe time pressures physicians often face during encounters with patients who have complex health problems could heighten their susceptibility to unconscious bias.
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Gordon HS, Pugach O, Berbaum ML, Ford ME. Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure. PATIENT EDUCATION AND COUNSELING 2014; 97:173-179. [PMID: 25088616 DOI: 10.1016/j.pec.2014.07.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 06/30/2014] [Accepted: 07/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine the associations of several characteristics with patients' trust in physician and the healthcare system. METHODS A prospective cohort of patients were followed after an exacerbation of heart failure at one of two veterans affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression. RESULTS After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P<0.001), but was not significantly different by race. Trust in VA did not change significantly over time (P>0.20), but was significantly lower for Black patients (P<0.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P<0.001). CONCLUSIONS Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among Black patients. Trust was higher when ratings of communication were higher. PRACTICE IMPLICATIONS Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system.
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Affiliation(s)
- Howard S Gordon
- Jesse Brown Veterans Affairs Medical Center, VA Center of Innovation for Management of Complex Chronic Healthcare, and Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, USA.
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - Michael L Berbaum
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, USA
| | - Marvella E Ford
- Department of Public Health Sciences and Hollings Cancer Center, Medical University of South Carolina, Charleston, USA
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Brown TM, Fee E. Paul B. Cornely (1906-2002): Civil rights leader and public health pioneer. Am J Public Health 2011; 101 Suppl 1:S164. [PMID: 21778476 DOI: 10.2105/ajph.2010.300052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Theodore M Brown
- History Department, University of Rochester, Rochester, NY 14627, USA.
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Washington HA, Baker RB, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, Wynia MK. Segregation, Civil Rights, and Health Disparities: The Legacy of African American Physicians and Organized Medicine, 1910-1968. J Natl Med Assoc 2009; 101:513-27. [DOI: 10.1016/s0027-9684(15)30936-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reynolds PP. A legislative history of federal assistance for health professions training in primary care medicine and dentistry in the United States, 1963-2008. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2008; 83:1004-14. [PMID: 18971650 DOI: 10.1097/acm.0b013e318189278c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article reviews the legislative history of Title VII of the United States Public Health Service Act. It describes three periods of federal support for health professions training in medicine and dentistry. During the first era, 1963 to 1975, federal support led to an increase in the overall production of physicians and dentists, primarily through grants for construction, renovation, and expansion of schools. The second period, 1976 to 1991, witnessed a shift in federal support to train physicians, dentists, and physician assistants in the fields of primary care defined as family medicine, general internal medicine, and general pediatrics. During this era, divisions of general internal medicine and general pediatrics, and departments of family medicine, were established in nearly every medical and osteopathic medical school. All three disciplines conducted primary care residencies, medical student clerkships, and faculty development programs. The third period, 1992 to present, emphasized the policy goals of caring for vulnerable populations, greater diversity in the health professions, and curricula innovations to prepare trainees for the future practice of medicine and dentistry. Again, Title VII grantees met these policy goals by designing curricula and creating clinical experiences to teach care of the homeless, persons with HIV, the elderly, and other vulnerable populations. Many grantees recruited underrepresented minorities into their programs as trainees and as faculty, and all of them designed and implemented new curricula to address emerging health priorities.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
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MESH Headings
- Academic Medical Centers/economics
- Education, Medical, Graduate/economics
- Education, Medical, Graduate/history
- Education, Medical, Graduate/trends
- Education, Medical, Undergraduate/economics
- Education, Medical, Undergraduate/history
- Education, Medical, Undergraduate/trends
- Family Practice/economics
- Family Practice/education
- Financing, Government/history
- Financing, Government/legislation & jurisprudence
- General Practice, Dental/economics
- General Practice, Dental/education
- History, 20th Century
- History, 21st Century
- Humans
- Physicians, Family/education
- Training Support/history
- Training Support/legislation & jurisprudence
- United States
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Affiliation(s)
- P Preston Reynolds
- Division of General Medicine, Geriatrics, and Palliative Care, Department of Medicine, Center for Biomedical Ethics and Humanities, University of Virginia, Charlottesville, Virginia, USA.
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Reynolds PP. Professional and hospital discrimination and the US Court of Appeals Fourth Circuit 1956-1967. Am J Public Health 2004; 94:710-20. [PMID: 15117685 PMCID: PMC1448322 DOI: 10.2105/ajph.94.5.710] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2003] [Indexed: 11/04/2022]
Abstract
A series of court cases litigated by the National Association for the Advancement of Colored People Legal Defense and Education Fund between 1956 and 1967 laid the foundation for elimination of overt discrimination in hospitals and professional associations. The landmark case, Simkins v Moses H. Cone Memorial Hospital (1963), challenged the use of public funds to expand segregated hospital care. The second case, Cypress v Newport News Hospital Association (1967), reaffirmed the federal government's application of Medicare certification guidelines to force hospitals to open up patient admissions, education programs, and staff privileges to all citizens and physicians. Pursuit of a legal strategy against racist policies was an essential element in a national campaign to eliminate discrimination in health care delivery in the United States.
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Affiliation(s)
- P Preston Reynolds
- National Library of Medicine, National Institutes of Health, Bethesda, MD, USA.
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Abstract
OBJECTIVE To examine whether process of hospital care differs among Hispanic, black, and white VA beneficiaries. SUBJECTS Two thousand eight-hundred fifty-two Hispanic, black, and white male VA beneficiaries from a case-control study discharged alive from one of twelve southern veterans hospitals with one of three diagnoses, diabetes mellitus (DM), congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD). METHODS We applied diagnosis-specific explicit criteria for the process of hospital care to each patient's hospital record and computed the adherence score; the percentage of applicable criteria performed during the hospital stay. We compared mean scores in Hispanic, black, and white patients and then compared adjusted scores using multiple linear regression. MAIN OUTCOME MEASURE Process of inpatient care (adherence score) in Hispanic, black, and white patients at admission, treatment, and discharge. RESULTS Mean admission adherence scores differed (P = 0.003) among Hispanic patients, black patients, and white patients for CHF and COPD, but not DM. Mean treatment and discharge scores were not different among Hispanic patients, black patients, and white patients. In bivariate comparisons, mean admission scores were higher in black patients compared with white patients for CHF (P= 0.003) and COPD (P= 0.01). In stratified analyses, admission and treatment scores were higher (P= 0.0001) in patients admitted to teaching compared with nonteaching hospitals. Process of inpatient care did not differ among Hispanic, black, and white patients after adjusting for admission to a teaching hospital and other covariates. CONCLUSION In contrast to findings in other studies, process of inpatient care was generally similar in Hispanic patients, black patients, and white patients. Our findings may reflect several characteristics of veterans' hospitals that may lead to care that is more equitable.
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Affiliation(s)
- Howard S Gordon
- Houston Center for Quality of Care and Utilization Studies, Section of General Medicine, Veterans Affairs Medical Center, TX, USA.
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Clayton LA, Byrd WM. Race: a major health status and outcome variable 1980-1999. J Natl Med Assoc 2001; 93:35S-54S. [PMID: 12653396 PMCID: PMC2593960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Based on the latest available data, African Americans are faced with persistent, or worsening, wide and deep, race-based health disparities compared to the white or general population as we enter the new millennium. These disparities are a 382-year continuum. There have been two periods of health reform specifically addressing the correction of race-based health disparities. The first period (1865-1872) was linked to Freedmen's Bureau legislation and the second (1965-1975) was a part of the Black Civil Rights Movement. Both had dramatic and positive effects on black health status and outcome, but were discontinued too soon to correct the "slave health deficit." Although African-American health status and outcome is slowly improving, black health has generally stagnated or deteriorated compared to whites since 1980. There is a compelling need for a third period of health reform accompanied by a cultural competence movement to address and correct persistent, often worsening, race-based health disparities.
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Affiliation(s)
- L A Clayton
- Harvard School of Public Health, Division of Public Health Practice, Boston, Massachusetts 02115, USA
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Byrd WM, Clayton LA. Race, medicine, and health care in the United States: a historical survey. J Natl Med Assoc 2001; 93:11S-34S. [PMID: 12653395 PMCID: PMC2593958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Racism in medicine, a problem with roots over 2,500 years old, is a historical continuum that continuously affects African-American health and the way they receive healthcare. Racism is, at least in part, responsible for the fact African Americans, since arriving as slaves, have had the worst health care, the worst health status, and the worst health outcome of any racial or ethnic group in the U.S. Many famous doctors, philosophers, and scientists of each historical era were involved in creating and perpetuating racial inferiority mythology and stereotypes. Such theories were routinely taught in U.S. medical schools in the 18th, 19th, and first half of the 20th centuries. The conceptualization of race moved from the biological to the sociological sphere with the march of science. The atmosphere created by racial inferiority theories and stereotypes, 246 years of black chattel slavery, along with biased educational processes, almost inevitably led to medical and scientific abuse, unethical experimentation, and overutilization of African-Americans as subjects for teaching and training purposes.
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Affiliation(s)
- W M Byrd
- Harvard School of Public Health, Division of Public Health Practice, Boston, MA 02115, USA
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Abstract
Louis Tompkins Wright, the son of a man born into slavery, was an outstanding African American surgeon who devoted his life to the racial integration of health care in the United States. Despite the fact that both his father and stepfather were physicians, despite his innate intellectual gifts and disciplined character, Wright experienced discrimination throughout his life and career. This experience led him to fight for the rights of African Americans, both health care professionals and patients. In addition to making numerous contributions in the fields of surgery and infectious disease, Wright held leadership positions in the National Association for the Advancement of Colored People for more than 20 years, leaving a legacy of equity for African Americans in medical education and in health care.
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Affiliation(s)
- P P Reynolds
- Department of Medicine, Johns Hopkins University, Baltimore, Md. 21205, USA.
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Brush BL. Has foreign nurse recruitment impeded African American access to nursing education and practice? Nurs Outlook 1999; 47:175-80. [PMID: 10523168 DOI: 10.1016/s0029-6554(99)90093-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- B L Brush
- Boston College School of Nursing, Chestnut Hill, Massachusetts, USA
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Affiliation(s)
- P B Gorelick
- Center for Stroke Research, Department of Neurological Sciences, Rush Medical Center, Chicago, Ill., USA
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