CHAPTER 6: CONCLUSION 137
6.4 Summary 148
In summary, PCC is shown to improve health status but its impact on health disparities is more complicated. Accordingly, it is incumbent on policy-makers to understand what PCC means in terms of specific health care practices and to address the linking of data sources to give providers the best, most accurate and current information about patient demographic and socioeconomic position if PCC is to become effective as a strategy to reduce racial disparities in health (Geppert et al., 2004). It is also incumbent on provider associations to produce effective training and continuing education to promote provider cultural competency and sensitivity to their patients’ unique circumstances. Finally, the U.S. health care system may be rich with
technology but it lacks one significant resource and that is time spent between provider and patient to understand and then negotiate diagnoses and treatment alternatives (Carter et al., 2003, Gross et al., 1998). The results of the most intricate Magnetic Resonance Imaging scan or blood chemistry panel are only cost-justified if the information is useful to clinical decision-making for a specific patient given their current demographic and socioeconomic circumstances and their understanding of the possible risks and benefits.
My study shows that PCC holds promise for reduced racial disparities in health but only in an environment where both provider and patient have the
knowledge, skills and abilities to benefit from provider-patient communication and negotiation. However, the rush to judgment such as implementation of financial incentives for PCC to reduce health disparities as currently addressed in public data sets and policy reports, is not justified.
APPENDIX A: LIST OF QUALITY CORE MEASURES NHDR, 2006
Core Quality Measure
Measured with
MEPS40?
Colorectal cancer incidence per 100,000 men and women age 50 and over diagnosed at advanced stage
No
Deaths per 100,000 persons due to colorectal cancer No
Adults age 40 and over with diabetes who had all three exams in last year: hemoglobin A1c test, retinal eye
examination, and foot examination
Yes
Hospital admissions for lower extremity amputations in patients with diabetes
No Dialysis patients registered on the waiting list for transplantation No
Hemodialysis patients with adequate dialysis No
Smokers receiving advice to quit smoking
Yes
Obese adults who were given advice about exercise
Yes
Hospital care for heart attack patients No
Hospital care for acute heart failure patients No
Deaths per 1,000 adult admissions with acute myocardial infarction
No
New AIDS cases among persons ages 13 and over No
Pregnant women receiving prenatal care in first trimester No Infant mortality per 1,000 live births, birth weight <1,500 grams No Children 19-35 months who received all recommended
vaccinations
No Adolescents (13-15) who received 3 or more doses of hepatitis B
vaccine
No Admissions for pediatric gastroenteritis per 100,000 population
age less than 18 years
No Children age 2-17 who received advice about healthy eating
from a doctor or other health provider
Yes
Children age 3-6 whose vision was checked by a doctor or other
health provider
Yes
Deaths due to suicide per 100,000 persons No
Adults with past year major depressive episode who received treatment for depression
No Persons age 12 and over who needed treatment for any illicit
drug use and who received such treatment at a Specialty facility
No
Persons receiving substance abuse treatment who completed the treatment course
No
40
Indicates that MEPS has reliable data to measure non-Hispanic black-white differences for this quality indicator.
Core Quality Measure
Measured with
MEPS40?
People 65 and over who ever received pneumonia vaccination No
Hospital care for pneumonia patients No
Antibiotics prescribed at visits with a diagnosis of common cold per 10,000 population
No Admissions for pediatric asthma per 100,000 population age less
than 18 years
No Tuberculosis (TB) patients who complete a curative course of
treatment within 12 months of initiation of treatment
No Long- stay nursing home residents who were physically
restrained
No High-risk long-stay nursing home residents who have pressure
sores
No Short- stay nursing home residents who have pressure sores No Home health care patients who get better at walking or moving
around
No Home health care patients who had to be admitted to the hospital No Surgical patients with postoperative pneumonia, urinary tract
infection, and/or venous thromboembolic event
No Surgical patients with appropriate timing of prophylactic
antibiotics
No Patients receiving central venous catheters with bloodstream
infection and/or mechanical adverse event
No Deaths per 1,000 discharges among patients with select
complications of care
No Elderly with at least one prescription for a potentially
inappropriate medication
Yes
Adults who can sometimes or never get care for illness or injury
as soon as wanted
Yes
Emergency department visits in which patient left before being seen
No
PATIENT CENTEREDNESS MEASURES:
Adults whose health providers sometimes or never listen carefully, explain things, show respect, and spend enough time with them
Yes
Children whose health providers sometimes or never listen carefully, explain things, show respect, and spend enough time with them
APPENDIX B: DETAILED SUMMARY OF PCC-RELATED LITERATURE
Journal Year Author(s) Title Cites % Total
Cites
Academic Medicine: Journal of the Association of Medical Colleges
2007 Beach, Rosner et al Can patient-centered attitudes reduce racial and ethnic disaprities in health?
0 0%
Aging Clinical and Experimental Research
2005 Oster, Smith et al Functional status and satisfaction with community participation in persons with stroke following medical rehabilitation
5 2%
American Journal of Public Health 2004 Johnson, Roter et al
Patient race/ethnicity and quality of patient-physician communication during medical visits
41 15%
American Journal of Medicine 2002 Stryer & Clancy Disparities in hospital transfer: Inequities, patient- centered care or both?
0 0%
American Journal of Obstetrics and Gynecology
2002 Hullfish, Bovbjerg et al
Patient-centered goals for pelvic floor dysfunction surgery: What is success and is it achieved?
15 5%
Annals of Allergy Asthma & Immunology
2005 Eisner, Katz et al Impact of depressive symptoms on adult asthma outcomes
9 3%
Annals of Internal Medicine 2003 Cooper, Roter et al Patient-centered communication, ratings of care and concordance of patient and physician race
80 29%
Archives of Pediatrics& Adolescent Medicine
2003 Wissow, Larson et al
Longitudinal care improves disclosure of psychosocial information
13 5%
Journal of General Internal Medicine 2005 Rencic & Liles The relationship between patient race and patients' perceptions of their physicians' cultural competence and patient- centered communication skills
0 0%
Journal of General Internal Medicine 1997 Cooper-Patrick, Powe et al
Identification of patient attitudes and preferences regarding treatment of depression
91 33%
Journal of Nursing Scholarship 2003 Radwin Cancer patient's
demographic characteristics and ratings of patient- centered nursing care
3 1%
Medical Care 2005 Dougherty, Meikle
et al
Children's health care in the first National Healthcare Quality Report and the National Healthcare Disparities Report
1 0%
Nursing Research 2004 Lauver, Gross et al Patient-centered interventions
3 1%
Nursing Research 1995 Minnick, Roberts et
al
An analysis of post hospitalization telephone survey data
5 2%
Psychology & Health 2000 Krupat, Yeager et al
Patient role orientations, doctor-patient fit, and visit satisfaction
10 4%
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