We Were All Created Equal – Man Made Us Different.

by Christopher Cornue

As we take a further look at the “disparities in health care” issue confronting all of us, this post will highlight a few of the individual organization/hospital efforts underway to increase culturally-specialized care and decrease disparities.

o In March 2007, UnitedHealthcare announced a partnership with the US Department of Health and Human Services’ Office of Minority Health to create a web-based cultural competency program for physicians. The intent is to create an increased sensitivity among care providers to improve care for racial and ethnic minorities. Among the areas of focus for the CME, self-directed courses are culturally competent care, linguistic services and organizational support.

o In Northeast Philadelphia, Frankford Hospitals System has implemented cultural outreach programs to address the needs of their increasing diverse patient population. Many hospitals across the United States have implemented similar initiatives to those adopted by Frankford Hospitals System, including:

- Spanish-speaking operators & a patient liaison to help patients navigate their hospital system and assist with scheduling appointments and treatments;
- Modified visiting hours for patients’ extended families;
- Spanish-language television stations;
- Menus, signs and other materials written in Spanish;
- Certification program for hospital employees, allowing for more medically trained healthcare interpreters.

o The Journal of the American Medical Association published an online study on 19 March 2007 detailing improvements in HIV, unintentional injury and other factors that demonstrate a narrowing of the life-expectancy gap between African Americans and Whites. While researchers from McGill University in Montreal, Canada note that significant disparities in care still endure, they found this gap dropped to an “all-time” low of 5.3 years in 2003, a reduction from 7.1 years in 1993. Among the factors contributing to this decline are lower relative heart disease mortality, reductions in mortality from homicide, HIV and unintentional injury. A further note from the researchers indicates that this decline doesn’t appear to come from general mortality improvements among African-Americans, but from specific improvement among specific age groups and causes of death. Heart disease mortality for older African-Americans did not improve.

o Ongoing efforts to address these disparities continue at the Disparities Solutions Center (DSC) at Massachusetts General Hospital. To help promote these efforts, the DSC, in collaboration with the National Committee for Quality Assurance and Joint Commission Resources, is leading a year-long executive education program called the Disparities Leadership Program, expected to launch in late May 2007. Healthcare organizations across the county applied to be a part of this program, and 15-20 organizations have already been selected to participate. For more information, please visit their website at http://www.massgeneral.org/disparitiessolutions/ .

There are many, many more examples illustrating efforts to address this issue. Through these examples and discussions about the literature, reports and publications supporting the evidence of disparities, it’s easy to see there are significant implications to everyone. If individuals are unable to receive treatment in a timely basis, a grim conclusion can often be appropriately drawn: patients may be more likely to die and the costs for more advanced treatments will rise. Additionally, our commitment to improve the health of individuals is decidedly compromised and as we move toward increased efforts to provide more preventative medicine, these examples are very compelling to say the least. So, what can we do to address this issue? How do we measure this “disparities issue” at our own institutions? The next few posts in this series will attempt to answer these questions.

This post is part of a 5-part series on healthcare disparities:
- Part 1: Introduction to Healthcare Disparities
- Part 2: A few healthcare organization role models to follow
- Part 3: Measuring disparities meaningfully
- Part 4: Two big disparities projects in the works
- Part 5: Cardio in African-Americans and Hispanics