Cook Ann, Grothaus Coraleen T, Gutierrez Carol E, Kehoe Kimberly A, Valentin Mona R
The Queen's Medical Center– Queen’s Heart, 1301 Punchbowl Street, Honolulu, HI 96813, USA.
Hawaii Med J. 2010 May;69(5 Suppl 2):7-10.
Queen's Heart, the cardiac service line at the Queen's Medical Center (QMC), Honolulu, Hawaii, recognizes the importance of closing the health disparity gap that affects the Native Hawaiian population. The purpose of this study was to examine the process and outcomes of health care among Native Hawaiians with heart disease, and to evaluate the impact of a multidisciplinary, culturally sensitive effort to improve quality of care. An inpatient program was created by assembling a team of practitioners who have an affinity for Native Hawaiian culture to address the health care of the Native Hawaiian people.
All Native Hawaiian patients who were admitted to The Queen's Medical Center from January 2007 to December 2008 became participants of the program. Baseline outcomes data for cardiac core measures, length of stay, 30 day readmission rates, and adverse events were reviewed by the team before the study was initiated. Educational materials were developed to provide culturally specific disease management information to patients and family members. The patient educators and discharge counselors provided patients with the education and tools they needed to engage in self care management. Heart failure disease management ensured that all Native Hawaiian patients receive appropriate quality care, individualized heart failure education, and a definitive plan for out patient follow up. The Integrative Care Program provided a holistic perspective of healing.
All quality indicators for Native Hawaiian patients with cardiac disease have improved. Patient satisfaction rates have remained at the 99th percentile. There has been a marked improvement in adverse events following percutaneous coronary interventions (PCI) for Native Hawaiian patients. Readmissions that occurred in less than 30 days for patients admitted with myocardial infarctions and heart failure have improved and are now essentially the same as all other patient populations.
Culturally sensitive and patient centered care, delivered by the team of specialists from Queen's Heart, has allowed patients to incorporate cultural preferences into their care and recovery. Readmission rates have decreased, mortality rates have improved, and patient and family satisfaction is enhanced.
位于夏威夷檀香山女王医疗中心（QMC）的心脏服务线“女王之心”认识到缩小影响夏威夷原住民人口的健康差距的重要性。本研究的目的是检查患有心脏病的夏威夷原住民的医疗保健过程和结果，并评估一项多学科、具有文化敏感性的努力对改善医疗质量的影响。通过组建一组对夏威夷原住民文化有亲和力的从业者团队，创建了一个住院项目，以解决夏威夷原住民的医疗保健问题。
2007年1月至2008年12月期间入住女王医疗中心的所有夏威夷原住民患者均成为该项目的参与者。在研究开始前，团队审查了心脏核心指标、住院时间、30天再入院率和不良事件的基线结果数据。开发了教育材料，为患者和家庭成员提供针对特定文化的疾病管理信息。患者教育者和出院顾问为患者提供了他们进行自我护理管理所需的教育和工具。心力衰竭疾病管理确保所有夏威夷原住民患者获得适当的优质护理、个性化的心力衰竭教育以及明确的门诊随访计划。综合护理项目提供了整体的康复视角。
患有心脏病的夏威夷原住民患者的所有质量指标均有所改善。患者满意度一直保持在第99百分位。夏威夷原住民患者经皮冠状动脉介入治疗（PCI）后的不良事件有显著改善。因心肌梗死和心力衰竭入院的患者在30天内的再入院情况有所改善，现在与所有其他患者群体基本相同。
由“女王之心”的专家团队提供的具有文化敏感性和以患者为中心的护理，使患者能够将文化偏好融入到他们的护理和康复中。再入院率降低，死亡率改善，患者和家属的满意度提高。
