Structural Racism In Historical And Modern US Health Care Policy

Yearby, Ruqaiijah; Clark, Brietta R.; Figueroa, José F.

doi:10.1377/hlthaff.2021.01466

Cited by 200 publications

(148 citation statements)

References 15 publications

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“…Racial and ethnic minorities—who are disproportionately at higher risk for LTBI—are more likely to be uninsured in the United States, highlighting structural discrimination that impacts access to LTBI care. 5 , 24 , 28 - 30 Although the World Health Organization states that achieving Universal Health Coverage is a key target for nations to achieve the sustainable development goals, US dialog around the Affordable Care Act and extension of its reach to cover the uninsured has slowed progress toward increasing patient access to care such as that for LTBI. The goal of Zero Catastrophic costs placed forward by the WHO End TB could include mitigation strategies for health inequities by engaging primary care providers already in the community of patients to decrease cost related to untreated LTBI progressing to TB disease that requires specialized care.…”

Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Verma

Pacheco

Carter

et al. 2022

J Prim Care Community Health

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Objectives: Within the United States (US), significant racial and ethnic disparities exist in the rates of latent TB infection (LTBI) and active TB disease. A disproportionate number of TB disease cases result from untreated LTBI among individuals born outside the US. This study evaluates LTBI treatment outcomes among an underserved, at-risk population in Rhode Island. Methods: A quantitative retrospective chart review of adult patients with a positive screening test assessed LTBI care cascade outcomes including referral, treatment initiation, and completion. Results: Seventy-four percent of patients found to have positive screening TB tests were born outside of the US; 80% identified as Hispanic or Black and 45% spoke a preferred language other than English. Twenty-one percent of potential candidates for LTBI treatment initiated treatment. Conclusions: Major gaps were identified in referral success and treatment initiation. Expanding LTBI treatment access into primary care settings could be a solution to improve outcomes and decrease health inequities among at-risk communities.

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Section: Discussionmentioning

confidence: 99%

Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island

Verma

Pacheco

Carter

et al. 2022

J Prim Care Community Health

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“…The findings of our review need to be interpreted within the broader socio-political context where more evidence is being shared regarding the colonial structures upon which our healthcare systems are built [96][97][98]. In particular, evidence pertaining to racist practices and policies, conscious and unconscious bias, and the outright discrimination and inequities in access to care experienced by racialized and marginalized groups [99,100].…”

Section: Discussionmentioning

confidence: 99%

Clinical ethics consultations: a scoping review of reported outcomes

et al. 2022

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Background Clinical ethics consultations (CEC) can be complex interventions, involving multiple methods, stakeholders, and competing ethical values. Despite longstanding calls for rigorous evaluation in the field, progress has been limited. The Medical Research Council (MRC) proposed guidelines for evaluating the effectiveness of complex interventions. The evaluation of CEC may benefit from application of the MRC framework to advance the transparency and methodological rigor of this field. A first step is to understand the outcomes measured in evaluations of CEC in healthcare settings. Objective The primary objective of this review was to identify and map the outcomes reported in primary studies of CEC. The secondary objective was to provide a comprehensive overview of CEC structures, processes, and roles to enhance understanding and to inform standardization. Methods We searched electronic databases to identify primary studies of CEC involving patients, substitute decision-makers and/or family members, clinicians, healthcare staff and leaders. Outcomes were mapped across five conceptual domains as identified a priori based on our clinical ethics experience and preliminary literature searches and revised based on our emerging interpretation of the data. These domains included personal factors, process factors, clinical factors, quality, and resource factors. Results Forty-eight studies were included in the review. Studies were highly heterogeneous and varied considerably regarding format and process of ethical intervention, credentials of interventionist, population of study, outcomes reported, and measures employed. In addition, few studies used validated measurement tools. The top three outcome domains that studies reported on were quality (n = 31), process factors (n = 23), and clinical factors (n = 19). The majority of studies examined multiple outcome domains. All five outcome domains were multidimensional and included a variety of subthemes. Conclusions This scoping review represents the initial phase of mapping the outcomes reported in primary studies of CEC and identifying gaps in the evidence. The confirmed lack of standardization represents a hindrance to the provision of high quality intervention and CEC scientific progress. Insights gained can inform the development of a core outcome set to standardize outcome measures in CEC evaluation research and enable scientifically rigorous efficacy trials of CEC.

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“…3 The NASEM report on Implementing High-Quality Primary Care calls for policies ensuring that high-quality primary care is available to every individual and family in every community and to train primary care teams where people live and work. 4 All of these recommendations have as the foundation that primary care decreases mortality at a population level. 5 An increased supply of primary care is associated with better population health and more equitable outcomes.…”

Section: Departments Of Family Medicine Meeting Post-covid Needsmentioning

confidence: 99%