Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States A Qualitative Study
Assessment of Perspectives on Health Care System Efforts to Mitigate Perceived Risks Among Immigrants in the United States A Qualitative Study
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DOI：
10.1001/jamanetworkopen.2020.3028
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发表时间：
2020-04-17
影响因子：
13.8
通讯作者：
Ryan, Gery W.
中科院分区：
文献类型：
--
作者：
Saadi, Altaf;Molina, Uriel Sanchez;Ryan, Gery W.
在2016年美国总统大选期间和之后，移民政策的执行，驱逐出境和批评移民的言论的增加与寻求健康的行为减少和移民中不良健康结果的增加有关。2016年总统大选后，解决移民医疗保健需求的努力集中在个人层面的患者-医生战略或联邦和州一级的政策变化上。然而，这些方法并没有抓住医疗保健系统的作用和医疗保健设施的范围内包含其中。目的描述卫生保健机构为解决移民身份相关压力源而实施的政策和行动。设计，设置，和参与者这个探索性的定性研究涉及半结构化的访谈，在一个有目的的样本的医疗保健设施在5个州（加州，得克萨斯州，纽约，佛罗里达，和伊利诺伊州）与最大的人口与无证移民身份。来自媒体来源的数据和对当地移民倡导领导人的信息访谈被用来确定实施欢迎政策和战略的医疗保健设施。利益相关者，包括管理人员，参与政策实施的一线临床医生和高级行政领导人，进行了采访。访谈于2018年5月1日至8月9日进行，并使用持续的比较分析进行记录，转录和编码。数据分析于2018年6月29日至2019年2月5日进行。主要成果和措施利益攸关方对为解决卫生保健设施中与移民有关的压力而实施的政策和行动的范围、范围和内容的看法。结果共进行了38次深入访谈，跨越25个卫生保健设施在5个州，这些设施包括13个联邦合格的卫生中心，7个学术或私立医院，和5个公共机构。受访者描述了减轻以下一种或多种感知风险的政策和行动：（1）在设施内或附近接触移民执法人员的风险，（2）移民身份相关信息披露的风险，（3）与患者层面压力源相关的风险，（4）与执法人员层面压力源相关的风险，以及（5）协调风险缓解。医疗机构的大多数工作人员强调，他们的政策和行动符合更大的使命和历史，满足不同患者的社会需求，减轻患者的风险。结论和相关性医疗机构可以实施积极和反应性的措施，以解决患者和从业人员之间的移民相关风险。人口健康和移民政策是当前政策辩论的重点。了解医疗机构如何减轻患者和员工的感知风险，可以成为优化移民医疗保健的一步。这项定性研究探讨了2016年总统大选后美国医疗机构为减轻移民和医疗从业者的感知风险而实施的政策和行动。问题医疗机构如何在2016年总统大选后采取行动，以减轻移民和医疗从业者的感知风险。在5个州的人口最多的个人与无证移民身份回应移民政策的执行后，2016年美国总统大选？结果-在这一定性研究涉及38个采访在25个医疗保健设施，这些设施被发现已经实施机构的政策和行动，以减轻感知风险的患者是移民和医疗保健从业人员。患者和从业人员确定的风险与暴露于移民执法人员或附近的设施和移民身份披露，这些风险与患者层面的压力源，与医生层面的压力源，并与风险缓解的协调。这项研究表明，了解医疗机构如何应对患者和员工的风险，可能有助于优化移民和医疗从业人员的护理。
Importance Increases in the enforcement of immigration policies, deportations, and rhetoric critical of immigration during and after the 2016 US presidential election have been associated with a decrease in health-seeking behaviors and an increase in adverse health outcomes among immigrants. Efforts to address the health care needs of immigrants after the 2016 presidential election have centered on individual-level patient-practitioner strategies or federal- and state-level policy changes. However, these approaches have not captured the role of health care systems and the range of health care facilities encompassed within them. Objective To characterize policies and actions implemented by health care facilities to address immigration status-related stressors. Design, Setting, and Participants This exploratory qualitative study involved semistructured interviews in a purposive sample of health care facilities across 5 states (California, Texas, New York, Florida, and Illinois) with the largest populations of individuals with undocumented immigration status. Data from media sources and informational interviews with local immigration advocacy leaders were used to identify health care facilities that had implemented welcoming policies and strategies. Stakeholders, including administrators, frontline clinicians involved in policy implementation, and senior executive leaders, were interviewed. Interviews were conducted between May 1 and August 9, 2018, and were recorded, transcribed, and coded using constant comparative analysis. Data analysis was performed from June 29, 2018, to February 5, 2019. Main Outcomes and Measures Stakeholder perspectives on the range, scope and content of policies and actions implemented to address immigration-related stressors at health care facilities. Results A total of 38 in-depth interviews were conducted spanning 25 health care facilities in 5 states; these facilities included 13 federally qualified health centers, 7 academic or private hospitals, and 5 public institutions. Interviewees described policies and actions that mitigated one or more of the following perceived risks: (1) risk of exposure to immigration enforcement personnel at or near facilities, (2) risk of immigration status-related information disclosure, (3) risk associated with patient-level stressors, (4) risk associated with practitioner-level stressors, and (5) coordination of risk mitigation. Most personnel at health care facilities emphasized that their policies and actions fit within a larger mission and history of addressing the social needs of diverse patients and mitigating risks for patients. Conclusions and Relevance Health care facilities can implement both active and reactive measures to address perceived immigration-associated risks among patients and practitioners. Population health and immigration policies are at the forefront of current policy debates. An understanding of the ways in which health care facilities can serve to mitigate perceived risks among their patients and employees can be one step toward optimizing health care for immigrants.This qualitative study explores the policies and actions implemented by US health care facilities after the 2016 presidential election in an effort to mitigate perceived risks among immigrants and health care practitioners.Question How have health care facilities in 5 states with the largest populations of individuals with undocumented immigration status responded to enforcement of immigration policies after the 2016 US presidential election? Findings In this qualitative study involving 38 interviews across 25 health care facilities, such facilities were found to have implemented institutional policies and actions to mitigate perceived risks among patients who are immigrants and health care practitioners. Patients and practitioners identified risks related to exposure to immigration enforcement personnel at or near facilities and of immigration status disclosure; these risks were associated with patient-level stressors, with practitioner-level stressors, and with coordination of risk mitigation. Meaning This study suggests that understanding the ways in which health care facilities address risks to their patients and employees may help to optimize care for patients who are immigrants and health care practitioners.