IMPROVING THE DELIVERY OF EFFECTIVE CARE TO MINORITIES

少数群体人口的健康状况可能比多数群体人口差，因为他们较少获得经证明有效的保健服务。与多数人口相比，这些未充分利用问题在少数群体中可能有不同的原因。增加提供有效保健服务的干预措施如果能够针对其所寻求补救的未充分利用问题的具体原因，则可能最为有效。在这个项目中，我们提出了一系列的4个协调项目，将衡量在纽约市的东部和中部哈莱姆的大型和种族多样化的社区中，选择的，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，以消除有针对性的根本原因的使用不足。具体而言，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）设计来检验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。我们将对从东部和中部哈莱姆4家医院存活出院的卒中患者进行抽样，评估4种经证实有效的预防卒中复发的治疗方法未充分使用的程度和原因。我们将使用随机对照试验设计，以评估护士管理的计算机化医生提醒系统的有效性，再加上改善患者教育，减少使用不足。我们将评估计算机化提醒系统的有效性，并提供反馈，以改善乳腺癌有效的局部和全身辅助治疗的使用不足。最后，我们将评估3种经证实有效的治疗早产的方法未充分使用的程度，并测量白人、黑人和西班牙裔之间未充分使用的差异。使用定性方法，我们还将探讨这些治疗使用不足的原因。该方案将作为一个综合整体实施，由行政、数据管理、实施和传播核心提供支持。这些核心将为各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。将通过我们与当地社区、州和国家组织的密切伙伴关系来传播成果。

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.