The American journal of managed care
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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.
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To use physician reports to evaluate their awareness of health plan tobacco control guidelines and cessation support coverage and to validate the extent to which health plan cessation support material had been disseminated and implemented in clinical settings. ⋯ Physician reports may be a useful way to verify health plan dissemination and implementation of tobacco control activities. Even these relatively high-performing plans have ample room for further improvement.
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Comparative Study
Examining healthcare disparities in a disease management population.
To examine whether racial disparities in healthcare exist in a heart failure population and to estimate the impact of disease management (DM) on any identified disparities. ⋯ Disparities in QOL were not observed between blacks and whites at baseline or over the course of the study. Disparities in functional status at baseline disappeared over time, implying that DM may help reduce disparities and maintain equity in healthcare outcomes.