Journal of general internal medicine
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Editorial Comment
The future of health disparities research: 2008 and beyond.
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Disparities in cancer survival may be related to differences in stage. Segregation may be associated with disparities in stage, particularly for cancers for which screening promotes survival. ⋯ Disparities in stages for cancers with an established screening test were smaller in more segregated areas.
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Addressing upstream or fundamental causes (such as poverty, limited education, and compromised healthcare access) is essential to reduce healthcare disparities. But such approaches are not sufficient, and downstream interventions, addressing the consequences of those fundamental causes within the context of any existing health system, are also necessary. We present a definition of healthcare disparities and two key principles (that healthcare is a social good and disparities in outcomes are a quality problem) that together provide a framework for addressing disparities downstream. Adapting the chronic care model, we examine a hierarchy of three domains for interventions (health system, provider-patient interactions, and clinical decision making) to reduce disparities downstream and discuss challenges to implementing the necessary changes.
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To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the "equal access" Veterans Affairs (VA) health care system. ⋯ Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.
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Multicenter Study Comparative Study Clinical Trial
Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D.
Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown. ⋯ Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.