The Mount Sinai journal of medicine, New York
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Substantial racial and ethnic disparities in health and health care exist in the United States. The Department of Health Policy at the Mount Sinai School of Medicine has developed a strategy for reducing those disparities that builds upon its quality improvement experience. ⋯ Parallels between our disparities research strategy and six sigma quality improvement methods are described. Finally, the article provides an example of how we have been able to successfully implement proven-effective health improvement programs in the Harlem community even after grant funding has ended.
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Diabetes prevalence and mortality are increasing, with minority populations disproportionately affected. Despite evidence that weight loss due to improved nutrition and increased physical activity can prevent or control diabetes, there is often a disconnect between this evidence and individuals' lifestyles. ⋯ This type of collaboration and the model may be useful tools to help communities identify and address the deficits that prevent their residents from enjoying the health benefits of improved nutrition and increased physical activity, and that also lead to racial and ethnic disparities in health.
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Black infants in the United States are more than twice as likely to die as White infants in the first year of life. Reducing the existing racial disparity in infant mortality rates is a major health policy focus. Despite decades of research aimed at reducing preterm births, our efforts have been largely unsuccessful. ⋯ However, it is an open question whether such improvements have reduced racial disparities in infant mortality. In this article, we recommend a new framework for addressing infant mortality disparities. We suggest that a quality of care problem may partially underlie racial disparities in infant mortality rates.
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Comparative Study
The success of recruiting minorities, women, and elderly into a randomized controlled effectiveness trial.
Heart failure, a leading cause of hospitalization among elderly people, disproportionately afflicts African-American and other non-White populations. Studies of health care interventions often do not include these groups in proportion to numbers in the patient population. Our objective was to assess whether a randomized controlled effectiveness trial enrolled patients by ethnicity/race, gender, and age in proportion to those eligible. ⋯ The recruitment strategy successfully enrolled patients by ethnicity/race, gender, and age through 74 years, but not those > or = 75 years. Registries of patients who refuse to enroll in trials could provide guidance for clinical and public policy.