PubMed · 15429486
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T G H HOGG. 1950-05-06. An address.. https://doi.org/10.5694/j.1326-5377.1950.tb80562.x
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BACKGROUND: Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities. METHODS: We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities. RESULTS: Twenty-seven studies met criteria for review. Almost all (n = 26) took place in the primary care setting, and most (n = 19) focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive) reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable), provider education alone (2 of 2 studies favorable), use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable), and use of remote simultaneous translation (1 of 1 study favorable). Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these strategies, as only one study reported cost data. CONCLUSION: There are several promising strategies that may improve health care quality for racial/ethnic minorities, but a lack of studies specifically targeting disease areas and processes of care for which disparities have been previously documented. Further research and funding is needed to evaluate strategies designed to reduce disparities in health care quality for racial/ethnic minorities.
Infants who start receiving immunizations on time are more likely to be up to date at age 2 years. Among 39708 infants aged 3 months covered by the Oregon Health Plan (expanded Medicaid), those who did not have health care coverage within the first month of life were less likely to start receiving immunizations on time. Also at risk were infants in foster care, in subadoptive care, who were blind or disabled, who were Native American or Black, or whose mothers were not covered by the Oregon Health Plan.
OBJECTIVE: To present an integrated model of help-seeking, review empirical work in its support, and show its application to the explanation of racial and ethnic disparities in infertility help-seeking. DESIGN: Review. SETTING: None. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): None. CONCLUSION(S): A help-seeking model provides a plausible explanation of observed disparities in infertility help-seeking. In addition to being related to income, race and ethnicity is related to prior experience with doctors, marital status, parity, knowledge and attitudes toward reproductive technology, and attitudes supporting spiritual rather than technological solutions to health problems.