Leveraging Quality Improvement to Achieve Equity in Health Care
Leveraging Quality Improvement to Achieve Equity in Health Care
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DOI：
10.1016/s1553-7250(10)36065-x
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发表时间：
2010-10-01
影响因子：
2.3
通讯作者：
Betancourt, Joseph R.
中科院分区：
文献类型：
--
作者：
Green, Alexander R.;Tan-McGrory, Aswita;Betancourt, Joseph R.
质量不平等：种族、民族、语言和其他弱势群体在医疗保健和质量方面的差异普遍且持续存在。卫生保健组织致力于总体上提高质量，但往往很少尝试解决差异。标准与文化上合格的质量改进 (QI)：大多数 QI 干预措施广泛针对普通人群，是一种“一刀切”的方法。这些标准的 QI 工作可能会优先提高更有优势的患者的质量，并维持甚至加剧现有的差异。具有文化能力的 QI 干预措施特别强调解决少数群体的独特需求和差异的根本原因。 QI 如何减少差异：QI 干预措施至少可以通过三种方式减少差异：（1）在某些情况下，标准 QI 干预措施可以更多地提高质量最低的人的质量，但这是不可靠的； （2）针对群体的QI干预可以通过优先针对差异群体来减少差异； (3) 具有文化能力的 QI 干预措施，通过针对造成差异的文化和语言障碍进行定制护理，可以改善对每个人的护理，尤其是对差异群体的护理。文化上合格的 QI 指南：文化上合格的 QI 方法应 (1) 识别差异并使用差异数据来指导和监测干预措施，(2) 解决特定差异群体特有的障碍，以及 (3) 解决许多差异群体常见的障碍。结论：实现健康公平医疗机构、医院和其他医疗保健组织应转向具有文化竞争力的 QI 和针对差异的 QI 干预措施，以实现医疗保健的公平性，这是质量的关键支柱。
Inequality in Quality: Disparities in health care and quality for racial, ethnic, linguistic, and other disadvantaged groups are widespread and persistent. Health care organizations are engaged in efforts to improve quality in general but often make little attempt to address disparities.Standard Versus Culturally Competent Quality Improvement (QI): Most QI interventions are broadly targeted to the general population-a "one-size-fits-all" ap proach. These standard QI efforts may preferentially improve quality for more advantaged patients and maintain or even worsen existing disparities. Culturally competent QI interventions place specific emphasis on addressing the unique needs of minority groups and the root causes of disparities.How QI Can Reduce Disparities: QI interventions can reduce disparities in at least three ways: (1) In some cases, standard QI interventions can improve quality more for those with the lowest quality, but this is unreliable; (2) group-targeted QI interventions can reduce disparities by preferentially targeting disparity groups; and (3) culturally competent QI interventions, by tailoring care to cultural and linguistic barriers that cause disparities, can improve care for everyone but especially for disparity groups.Guidelines for Culturally Competent QI: A culturally competent approach to QI should (1) identify disparities and use disparities data to guide and monitor interventions, (2) address barriers unique to specific disparity groups, and (3) address barriers common to many disparity groups.Conclusions: To achieve equity in health care, hospitals and other health care organizations should move toward culturally competent QI and disparities-targeted QI interventions to achieve equity in health care, a key pillar of quality.