Gaston-Johansson Fannie, Hill-Briggs Felicia, Oguntomilade Lola, Bradley Vanessa, Mason Phyllis
Acute and Chronic Care Department, Johns Hopkins University, School of Nursing, Baltimore, MD 21205, USA.
J Natl Black Nurses Assoc. 2007 Dec;18(2):43-52.
The existence of racial and ethnic disparities in healthcare in the United States is well recognized. However, often overlooked in the planning and design of initiatives to address those disparities are the patient perspectives regarding the issues of racial and ethnic disparities that directly affect them. The objective of this study was to identify the patient priorities and to provide recommendations for action to improve minority health-care quality. A secondary objective was the qualitative analysis of the Institute of Medicine (IOM) focus group data. Six focus groups were conducted with nine participants in each. These included an African-American focus group in Washington, D.C., an African-American focus group in Los Angeles, an Asian focus group in Los Angeles, an Hispanic focus group in Washington, D.C., an Hispanic focus group in Los Angeles, and a Native American focus group in Albuquerque, NM. The barriers and priorities for action included difficulty in making informed choices when identifying and selecting providers, poor service delivery from medical office staff, the inefficiency of medical visits, provider communication and cultural competence barriers, and stressful treatment settings. Patient recommendations targeted provision of tools to empower patients throughout the process of care, provider and staff training in communication and cultural competence, alternate models of service delivery, and accessible mechanisms for evaluation and oversight. This study concluded that patient-identified priorities and recommendations warranted modification of current explanatory models for minority health-care quality and the provision of greater clarity regarding directions for policy and behavioral initiatives and criteria for performance evaluation be advanced.
美国医疗保健领域存在的种族和族裔差异已得到广泛认可。然而，在制定和设计解决这些差异的举措时，往往被忽视的是患者对直接影响他们的种族和族裔差异问题的看法。本研究的目的是确定患者的优先事项，并为改善少数族裔医疗保健质量提供行动建议。次要目标是对医学研究所（IOM）焦点小组数据进行定性分析。共进行了六个焦点小组，每个小组有九名参与者。其中包括一个位于华盛顿特区的非裔美国人焦点小组、一个位于洛杉矶的非裔美国人焦点小组、一个位于洛杉矶的亚裔焦点小组、一个位于华盛顿特区的西班牙裔焦点小组、一个位于洛杉矶的西班牙裔焦点小组以及一个位于新墨西哥州阿尔伯克基的美国原住民焦点小组。行动的障碍和优先事项包括在识别和选择医疗服务提供者时难以做出明智选择、医疗办公室工作人员服务不佳、就诊效率低下、医疗服务提供者沟通和文化能力障碍以及治疗环境压力大。患者的建议旨在提供工具，使患者在整个护理过程中能够增强能力，对医疗服务提供者和工作人员进行沟通和文化能力培训，并提供替代的服务提供模式以及便于使用的评估和监督机制。本研究得出结论，患者确定的优先事项和建议有必要修改当前关于少数族裔医疗保健质量的解释模型，并更明确地说明政策和行为举措的方向以及绩效评估标准。
