Designing and evaluating interventions to eliminate racial and ethnic disparities in health care
Designing and evaluating interventions to eliminate racial and ethnic disparities in health care
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DOI：
10.1046/j.1525-1497.2002.10633.x
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发表时间：
2002-06-01
影响因子：
5.7
通讯作者：
Powe, NR
中科院分区：
文献类型：
--
作者：
Cooper, LA;Hill, MN;Powe, NR
造成种族和民族健康状况差异的因素很多。一段时间以来，卫生保健专业人员、研究人员和政策制定者一直认为，获得医疗服务是消除这些健康差距的核心。医学研究所（IOM）获得卫生服务的模式包括个人、财政和结构障碍、卫生服务利用和护理中介。该模型可用于描述这些因素之间的相互作用及其对种族和族裔群体之间的健康结果和服务公平性的影响。我们提出了IOM模型的修改版本，该模型结合了其他获取模型的特征，并突出了与旨在消除美国医疗保健差距的干预措施相关的障碍和中介因素。我们还建议，在提高保健质量的更广泛背景下考虑消除差距和实现保健服务公平的干预措施。一些保健服务干预研究表明，弱势群体的健康状况有所改善。如果设计和实施得当，这些干预措施可用于减少健康差距。干预措施的成功特点包括采用多方面、密集的方法、在文化和语言上适当的方法、改善获得护理的机会、因地制宜、与利益攸关方建立伙伴关系以及社区参与。然而，为了有效地减少卫生保健和健康状况的差异，需要解决先前研究的重要局限性，包括缺乏对照组，实验干预措施的受试者非随机分配，以及使用未经验证的健康结果测量。针对高危人群，着重于最重要的促成因素，包括适当性和护理质量和保健结果的措施，以及优先考虑传播工作，可以改进干预措施。
A large number of factors contribute to racial and ethnic disparities in health status. Health care professionals, researchers, and policymakers have believed for some time that access to care is the centerpiece in the elimination of these health disparities. The Institute of Medicine's (IOM) model of access to health services includes personal, financial, and structural barriers, health service utilization, and mediators of care. This model can be used to describe the interactions among these factors and their impact on health outcomes and equity of services among racial and ethnic groups. We present a modified version of the IOM model that Incorporates the features of other access models and highlights barriers and mediators that are relevant for interventions designed to eliminate disparities in U.S. health care. We also suggest that interventions to eliminate disparities and achieve equity in health care services be considered within the broader context of improving quality of care. Some health service intervention studies have shown improvements in the health of disadvantaged groups. If properly designed and implemented, these Interventions could be used to reduce health disparities. Successful features of interventions include the use of multifaceted, intense approaches, culturally and linguistically appropriate methods, improved access to care, tailoring, the establishment of partnerships with stakeholders, and community involvement. However, in order to be effective in reducing disparities in health care and health status, important limitations of previous studies need to be addressed, including the lack of control groups, nonrandom assignment of subjects to experimental interventions, and use of health outcome measures that are not validated. Interventions might be Improved by targeting high-risk populations, focusing on the most important contributing factors, including measures of appropriateness and quality of care and health outcomes, and prioritizing dissemination efforts.