Toward Health Equity and Patient-Centeredness Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary (2009) / Chapter Skim
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4 Integration at the Practitioner Level
4 Integration at the Practitioner Level
Pages 41-54
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From page 41... ...
, a 37,000-member organization, has taken a great interest in the issues of health disparities and health literacy. Fifty-four percent of its members have electronic health records in their offices, a necessary tool for the application of evidence-based clinical decision making.
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From page 42... ...
This methodology combines geocoding and name analysis to develop race and ethnicity estimates that can be rolled up to characterize health care quality improvement needs at a variety of levels, including the regional level, health plan level, and provider practice group level. WellPoint has also engaged physician groups in quality improvement initiatives to address disparities.
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From page 43... ...
Through the development of new materials to disseminate information, WellPoint hopes to address fears by producing improved, individually relevant targeted information. Second, benefit structures are undergoing changes to reduce the financial burden of care.
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From page 44... ...
Recognizing that clinical decision support tools and patient mailings alone were insufficient to achieve good diabetes care, the next phase of improvement focused on restructuring chronic care delivery. This led to changes in the HVMA primary care system that identified new roles for all care team members, including nurse practitioners, nurses, and medical assistants, and additional training in such areas as health promotion and patient engagement.
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From page 45... ...
However, a significant gap in rates of cholesterol control between white and black patients unfortunately persisted. One potential reason for this gap is a persistent difference in prescribing behaviors of physicians, with black patients remaining less likely than whites to be prescribed statins. It is important to note that the focus of these interventions within the HVMA primary care system was not to improve minority care or to reduce disparities -- it was to improve the quality of care for patients with chronic conditions, exemplifying the positive impact quality improvement interventions can have on disparities.
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From page 46... ...
A potentially useful strategy might be to make clinicians more aware of their performance through nonpublic performance reporting of racial disparities. Health care systems should explore training in cultural competency for clinicians to raise awareness of disparities and ultimately improve communication with minority patients regarding the management of their chronic condition (e.g., choosing healthy foods, getting proper exercise, and controlling stress)
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From page 47... ...
A randomized trial of these interventions was conducted with 130 patients. The incidence rate for hospitalizations and death decreased by almost 40 percent for those receiving the self-care program as compared to those who received a standard heart failure pamphlet alone (DeWalt et al., 2004b)
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From page 48... ...
Third, political advocacy should be cultivated to organize low-literacy patients to garner attention to their needs. The infrastructure for implementing health care quality improvement exists primarily in inpatient settings.
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From page 49... ...
The health care system should be viewed as a full system working in both settings, as opposed to separate inpatient and outpatient systems, thus facilitating a more systemic focus on care transitions. For the future, Pignone concluded, universal recognition of barriers to high-quality care is critical and requires the involvement of institutional leadership, which is currently lacking in many places.
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From page 50... ...
The National Health Plan Disparities Collaborative consists of 11 health plans, both national and regional, from around the country.
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From page 51... ...
Second, culturally tailored quality improvement interventions are more effective than general quality improvement interventions, as noted by Ting and Sequist. This conclusion was also found in the Finding Answers program, where being respectful of patients' health beliefs and behaviors -- even having culturally appropriate artwork -- led to the building of trust between patients and providers, critical in efforts to reduce disparities.
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From page 52... ...
These bridges must be built to strengthen the health care system and achieve the goal of integrating health literacy, disparities reduction, and quality improvement. Steve Somers, Ph.D.
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From page 53... ...
Data should be gathered on these populations and be used to improve their care, with the goal of better health. Somers concluded with the hope that CHCS's programs in states with high concentrations of diverse populations and often poor quality scores could stimulate cross-stakeholder and cross-payer collaborations (i.e., state and health plans work together with providers to improve quality, reduce disparities, and address health literacy)
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From page 54... ...
Medical Home In response to a question of whether the concept of medical homes should begin with physicians or potentially be viewed with a focus on nurses, community health workers, or patient navigators, Chin responded that many benefits exist to having a comprehensive, multidisciplinary team focus. The effectiveness of nurse-led systems and team interventions is a common theme found in disparities intervention literature.
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