Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change National Program Office, University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2012 Aug;27(8):992-1000. doi: 10.1007/s11606-012-2082-9.
Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.
在过去的十年中,研究人员的关注点已经从记录医疗保健差距转变为寻找缩小护理差距的解决方案。作为罗伯特伍德约翰逊基金会的一个全国性项目,“寻找答案:改变差异研究”的任务是确定有希望的干预措施,以减少差异。基于我们对文献进行系统评价、评估有前途的实践以及向医疗保健组织提供技术援助的工作,我们为减少护理中的种族和民族差异制定了路线图。该路线图概述了一个动态过程,其中个别干预措施只是其中的一部分。它强调,组织和提供者需要为减少差异负责,建立一个改善质量的一般基础设施和文化,并将有针对性的差异干预措施纳入质量改进工作中。此外,我们总结了通过“寻找答案”计划获得的主要经验教训。我们分享实施差异干预措施的最佳实践,并从 12 项文献系统评价中综合跨领域主题。我们的研究表明,有希望的干预措施通常是根据患者的需求进行文化调整的,采用多学科的护理提供者团队,并针对患者护理途径中的多个杠杆点。使用互动技术提供技能培训的健康教育似乎比传统的教学方法更有效。此外,患者导航和让家庭和社区成员参与医疗保健过程可能会改善少数民族患者的结果。我们预计,该路线图和最佳实践将对努力提供高质量公平护理的组织、政策制定者和研究人员有用。