IMPROVING THE DELIVERY OF EFFECTIVE CARE TO MINORITIES

少数民族人口的健康状况可能比多数人口差，因为他们获得经证明有效的卫生保健服务的频率较低。这些未充分利用的问题在少数群体和多数群体中可能有不同的原因。为增加有效保健服务的提供而采取的干预措施，如果能够针对其所要补救的使用不足问题的具体原因进行调整，则可能是最有效的。在这个项目中，我们提出了一系列4个协调的项目，这些项目将衡量在纽约市哈莱姆东区和中部种族多样化的大型社区中，选定的、被证明有效的医疗和外科干预措施的使用不足。我们将评估这些未充分利用问题的根本原因。我们将制定、实施和评估干预措施，以消除针对潜在原因的使用不足。具体来说，在东部和中部哈莱姆黑人和西班牙裔的样本中，我们将评估高血压控制不良的程度，并评估这些失败的患者、医生和系统原因。我们将采用随机对照试验（RCT）设计来测试护士病例管理干预对改善东部和中部哈莱姆黑人和西班牙裔高血压控制的有效性。在4个东部和中部哈莱姆医院的中风患者活着出院的样本中，我们将评估4种被证明有效的治疗方法在预防复发性中风方面使用不足的程度和原因。我们将采用随机对照试验设计来评估护士管理的计算机医生提醒系统的有效性，并结合改进的患者教育来减少使用不足。我们将评估计算机提醒系统的有效性，该系统对改善乳腺癌局部和全身辅助治疗使用不足的情况提供反馈。最后，我们将评估三种经证实有效的早产治疗方法的使用不足程度，并衡量白人、黑人和西班牙裔人在使用不足方面的差异。使用定性方法，我们还将探讨这些治疗方法使用不足的原因。该计划将作为一个整体实施，由行政、数据管理、实施和传播核心提供支持。这些核心将为跨项目的共同研究方法和需求提供支持，并确保项目得到协调，并从彼此的经验中受益。成果的传播将通过我们与地方社区、州和国家组织的密切伙伴关系来完成。

Minority populations may experience poorer health status than majority populations because they because they receive proven-effective health care services less often. These underuse problems may have different causes in minority compared with majority populations. Interventions to increase the delivery of effective health care services are likely to be most effective if they are tailored to address the specific causes of the underuse problems they seek to remedy. In this program, we propose a series of 4 coordinated projects that will measure the underuse of selected, proven-effective medical and surgical interventions in the large and ethnically-diverse communities of East and Central Harlem in New York City. We will assess the underlying causes of these underuse problems. We will develop, implement, and evaluate interventions to eliminated underuse by targeted underlying causes. Specifically, in a sample of East and Central Harlem Blacks and Hispanics, we will assess the magnitude of poor control of hypertension and assess patient, physician, and system reasons for these failures. We will use a randomized controlled trial (RCT) design to test the effectiveness of a nurse case management intervention to improve hypert4ension control among East and Central Harlem Blacks and Hispanics. In a sample of patients discharged alive from 4 East and Central Harlem hospitals with stroke, we will assess the magnitude and reasons for underuse of 4 proven-effective treatments for prevention of recurrent stroke. We will use an RCT design to evaluate the effectiveness of a nurse-managed computerized physician reminder system coupled with improved patient education on decreasing underuse. We will assess the effectiveness of a computerized reminder system with feedback on improving underuse of effective local and systemic adjuvant treatments for breast cancer. Finally, we will assess the magnitude of underuse of 3 proven-effective treatments for managing premature births and measure differences in underuse among Whites, Blacks, and Hispanics. Using qualitative methods, we will also explore reasons for underuse of these treatments. This program will be implemented as an integrated whole, supported by administrative, data management, and implementation and dissemination cores. These cores will provide support for common research methods and needs across projects and assure that projects are coordinated and benefit from each other's experiences. Dissemination of results will be accomplished through our close partnership with local community, state and national organizations.