IMPROVING THE DELIVERY OF EFFECTIVE CARE TO MINORITIES

少数群体的健康状况可能比多数群体更差，因为他们较少获得被证明有效的卫生保健服务。这些利用不足的问题在少数群体中可能有不同于多数人的原因。为增加有效保健服务的提供而采取的干预措施如果是针对他们寻求补救的利用不足问题的具体原因而量身定做的，则可能是最有效的。在这项计划中，我们提出了一系列4个协调项目，以衡量在纽约市东哈莱姆区和中部哈莱姆区的大型、种族多元化的社区中，精选的、被证明有效的内科和外科干预措施使用不足的情况。我们将评估这些未充分利用问题的根本原因。我们将制定、实施和评估旨在通过有针对性的根本原因消除使用不足的干预措施。具体地说，在东部和中部哈莱姆区黑人和西班牙裔美国人的样本中，我们将评估高血压控制不良的程度，并评估导致这些失败的患者、医生和系统原因。我们将使用随机对照试验(RCT)设计来测试护士病例管理干预的有效性，以改善东哈莱姆区和中部哈莱姆区黑人和拉美裔美国人的高血压控制。在哈莱姆区东部和中部4家医院出院的中风患者样本中，我们将评估4种被证明有效的预防中风复发的治疗方法使用不足的程度和原因。我们将使用随机对照试验设计来评估护士管理的计算机化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，并提供反馈，以改善乳腺癌局部和全身有效辅助治疗的使用不足情况。最后，我们将评估3种被证明有效的早产治疗方法使用不足的程度，并衡量白人、黑人和西班牙裔之间使用不足的差异。我们还将采用定性的方法，探索这些治疗方法使用不足的原因。该方案将作为一个综合整体实施，由行政、数据管理以及执行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。我们将通过与当地社区、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.