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National Healthcare Disparities Report Recommendations |
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Home --> Health Equity Toolbox --> Upstream Strategies for Health Care Providers --> National Healthcare Disparities, Recommendations
1. Collect valid and reliable data on race, ethnicity, and language preference.
Although data collection alone is not sufficient for reducing disparities, it is a critical first step to identifying the health care needs of specific populations and gaps in care. National efforts, including requirements of the ACA and data standards produced by the HHS Office of Minority Health, are promoting better data systems. In addition, the Institute of Medicine developed recommendations to identify of disparities in care, including: collecting standardized self-reported patient race, ethnicity, and language (REL) data and using those data to examine differences in quality of care between groups (Ulmer, McFadden, & Nerenz, 2009). Ultimately, these data can be used to develop quality improvement interventions tailored to specific groups, and the Institute of Medicine provides additional guidelines to this end. Lessons learned regarding efforts to collect and incorporate REL data into quality improvement initiatives are highlighted in an issue brief describing the Robert Wood Johnson Foundation’s (RWJF) Aligning Forces for Quality (AF4Q) Initiative, which can be found here. Related tools and additional resources to support REL data collection and standardization can be found in the RWJF Equity Resource Guide.
2. Diversify and ensure a culturally competent workforce.
There is evidence that the quality of care for racial and ethnic minorities improves when the workforce reflects the characteristics of the patient population (Smedley, Stith Butler, & Bristow, 2004). Provider diversity is a key element of patient-centered care and may be achieved through the recruitment, retention, and training of racially, ethnically, and culturally diverse individuals. This requires a concerted effort, particularly by leadership within health care organizations and other state systems. The HHS Action Plan for Reducing Racial and Ethnic Health Disparities (2011) specifically recommends creating an undergraduate pipeline program to increase the diversity of students entering health professions. Other strategies to address gaps in the diversity of the workforce include expanding the use of interpreters to overcome language barriers and improving cultural competence education and professional development for health care providers. TheU.S. Department of Health Human Services (HHS) provides a web-based training opportunity for physicians regarding cultural competency, called A Physician’s Practical Guide to Culturally Competent Care. Although the training focuses on physicians, all health care providers may benefit from the training, which is accessible here.
3. Build community partnerships for research and action
Similar to the principles underlying place-based strategies for promoting health equity, providers and researchers need to embrace community partnerships. The National Partnership for Action’s National Stakeholder Strategy (2011) specifically calls for greater investments in community-based participatory research, which is research that involves community engagement throughout the entire research process, and evaluates community- oriented intervention strategies. Similarly, to promote health equity across the continuum of health-related services, the National Stakeholder Strategy recommends increased support for and improved coordination of research that enhances our understanding of strategies. Finally, more attention is needed to enhance the transfer of knowledge and translation of research at the program, community, system and policy levels.
Sample Strategy
In Delaware, the Delaware Clinical and Translational Research ACCEL Program (DE- CTR) offers a mechanism for community partnerships and research translation. The DE- CTR is a partnership between the University of Delaware, Christiana Care Health Services, Nemours Health and Prevention Services/Alfred I. duPont Hospital for Children, and the Medical University of South Carolina (MUSC). It aims to improve the state’s infrastructure and capacity for conducting research that can be applied to effective interventions that lead to better clinical outcomes. The DE-CTR ACCEL program is supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health (under grant number U54-GM104941, PI: Binder-Macleod). The DE-CTR program includes a strategic partnership with the Medical University of South Carolina, which provides technical assistance and support. With an emphasis on community outreach and engagement, the DE-CTR is particularly well positioned to support community-based participatory research and research translation for health equity. For more information about the DE- CTR program and related funding and research opportunities, click here.
4. Implement evidence-based interventions and promising practices for advancing health equity.
Scholars and professionals alike are increasingly recognizing the potential impact of health care system changes and specific interventions for advancing health equity. Providers can find ideas, emerging practices, lessons learned, tools, and other resources through linkages with other providers. As mentioned on page 99, HealthBegins is a social network where clinicians can learn and share upstream strategies. Examples of promising strategies shared by this network include the “Yelp for Help” pilot program in Los Angeles, where providers partnered with a charter school focused on preparing students for careers in the health field. Students learned about social determinants and then helped to map over 230 local “health-critical” community resources related to food insecurity, slum housing, adult education, job training, and other social determinants. The resources were uploaded to a searchable web-based platform with mapping capabilities. Learn more about “Yelp for Help,”. For more information about the HealthBegins network and to access all of the shared resources, click here.
5. Engage in the policy process.
Health and health equity are inherently political. The SDOH are determined by policy processes and decisions that tend to favor those with power and other resources. Policy changes are needed to facilitate the health care system changes that will help alleviate health inequities. Health care providers can be leaders in the policy arena by advocating for their patients’ social needs. Similarly, providers can lend their expertise to policy discussions outside of the health care sector, but which have an impact on health.