Griffith Derek M, Yonas Michael, Mason Mondi, Havens Betsy E
University of Michigan School of Public Health in Ann Arbor, Michigan, USA.
Health Promot Pract. 2010 May;11(3):367-76. doi: 10.1177/1524839908330863. Epub 2009 Apr 3.
Policy makers and practitioners have yet to successfully understand and eliminate persistent racial differences in health care quality. Interventions to address these racial health care disparities have largely focused on increasing cultural awareness and sensitivity, promoting culturally competent care, and increasing providers' adherence to evidence-based guidelines. Although these strategies have improved some proximal factors associated with service provision, they have not had a strong impact on racial health care disparities. Interventions to date have had limited impact on racial differences in health care quality, in part, because they have not adequately considered or addressed organizational and institutional factors. In this article, we describe an emerging intervention strategy to reduce health care disparities called dismantling (undoing) racism and how it has been adapted to a rural public health department and an urban medical system. These examples illustrate the importance of adapting interventions to the organizational and institutional context and have important implications for practitioners and policy makers.
政策制定者和从业者尚未成功理解并消除医疗保健质量方面持续存在的种族差异。解决这些种族医疗保健差距的干预措施主要集中在提高文化意识和敏感度、推广具有文化胜任力的护理，以及增强医疗服务提供者对循证指南的遵循度。尽管这些策略改善了一些与服务提供相关的近端因素，但它们对种族医疗保健差距并未产生重大影响。迄今为止，干预措施对医疗保健质量方面的种族差异影响有限，部分原因在于它们没有充分考虑或解决组织和制度因素。在本文中，我们描述了一种新兴的减少医疗保健差距的干预策略，即消除（解构）种族主义，以及它是如何被应用于一个农村公共卫生部门和一个城市医疗系统的。这些例子说明了使干预措施适应组织和制度背景的重要性，并对从业者和政策制定者具有重要意义。
