The American journal of managed care
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Research conducted by James Caro, MDCM, focuses on the economic costs of stroke in patients with atrial fibrillation (AF), and how much can be saved by optimizing anticoagulation in these patients. His research will have practical implications not only for researchers but also the clinicians and decision makers within managed care settings who must allocate resources for competing prevention programs. ⋯ Caro recently reported preliminary results from his economic analyses at the 2004 World Stroke Congress in Vancouver, BC. He spoke with an editor from AJMC about those studies.
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The authors argue that the American healthcare system has developed in a fashion that permits and may support ongoing, widespread inequities based on poverty, race, gender, and ethnicity. Institutional structures also contribute to this problem. Analysis is based on (1) discussions of a group of experts convened by the Office of Minority Health, US Department of Health and Human Services at a conference to address healthcare disparities; and (2) review of documentation and scientific literature focused on health, health-related news, language, healthcare financing, and the law. ⋯ Recommendations include establishment of core attributes of trust, relationship and advocacy in health systems; universal healthcare; and insurance systems based on mutual aid. In addition, monitoring of equity in health services and the development of a set of ethical principles to guide systems change and rule setting would provide a foundation for distributive justice in healthcare. Additionally, training centers should model the behaviors they seek to foster and be accountable to the communities they serve.
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Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. ⋯ Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based data and analyses by race, ethnicity, education level, and patient's primary language are critical steps for MCOs to better understand their patients' healthcare status and improve their care. Research and experience have shown that by acknowledging the unique healthcare conditions of low-income racial and ethnic minority populations and by recruiting and hiring primary care providers who have a commitment to treat underserved populations, costs are reduced and patients are more satisfied with the quality of care.
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The role of culturally competent communication in reducing ethnic and racial healthcare disparities.
Promoting culturally competent communication at the provider, care institution, health plan, and national levels is likely to contribute to success in reducing racial and ethnic disparities in the receipt of high quality care. Although some health plans recently have shown interest in addressing racial and ethnic disparities in care, very few have addressed how health plans can improve their cultural competency to reduce disparities. This commentary summarizes the importance of culturally competent communication across several levels of the healthcare system and details concrete steps that managed care organizations can take to maximize their ability to provide culturally competent communication and care.
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Health-related quality-of-life instruments can yield important health information that is often distinct from objective measures of symptoms and disease severity that clinicians are most attuned to. Comprehensive health assessment can be difficult because there are many available measurement instruments that vary in their scope and content. ⋯ The Assessing the Impact of Disease framework aims to clarify the process of selecting appropriate assessment instruments. Three common diseases are discussed in depth to illustrate the applicability of Assessing the Impact of Disease in distinguishing between symptom, severity, and health-related quality-of-life measurements.