Department of Health Policy and Management, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD.
Department of Health Policy and Management, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD; The Hospital and Public Health InterdisciPlinarY Research (HAPPY) Lab, School of Public Health, University of Maryland, College Park (JC, PB, MRTS), MD.
Am J Geriatr Psychiatry. 2022 Nov;30(11):1171-1179. doi: 10.1016/j.jagp.2022.04.010. Epub 2022 May 6.
Black and Latinx Americans are disproportionately at greater risk for having Alzheimer's disease and related dementias (ADRD) than White Americans. Such differences in risk for ADRD are arguably explained through health disparities, social inequities, and historical policies. Structural racism and discrimination (SRD), defined as "macro-level conditions that limit opportunities, resources, and well-being of less privileged groups," have been linked with common comorbidities of ADRD, including hypertension, obesity, diabetes, depression. Given the historical impact of SRD-including discriminatory housing policies resulting in racial residential segregation that has been shown to limit access to education, employment, and healthcare-Black and Latinx populations with ADRD are directly or indirectly negatively affected by SRD in terms of access, quality and cost for healthcare. Emerging studies have brought to light the value of structural-level hospital and public health collaboration on care coordination for improving healthcare quality and access, and thus could serve as a macro-level mechanism for addressing disparities for minoritized racial and ethnic populations with ADRD. This paper presents a conceptual framework delineating how care coordination can successfully be achieved through health information technology (HIT) systems and ultimately address SRD. To address health inequities, it is therefore critical that policy initiatives invest in HIT capacities and infrastructures to promote care coordination, identify patient needs and preferences, and promote engagement of patients with ADRD and their caregivers.
黑人和拉丁裔美国人比白种人更容易患上阿尔茨海默病和相关痴呆症（ADRD）。这种 ADRD 风险的差异可以通过健康差距、社会不平等和历史政策来解释。结构性种族主义和歧视（SRD）被定义为“限制弱势群体机会、资源和福祉的宏观条件”，与 ADRD 的常见合并症有关，包括高血压、肥胖症、糖尿病、抑郁症。鉴于 SRD 的历史影响——包括导致种族隔离的歧视性住房政策，这已被证明限制了获得教育、就业和医疗保健的机会——患有 ADRD 的黑人和拉丁裔人群在获得医疗保健方面直接或间接地受到 SRD 的负面影响，包括质量和成本。新兴研究揭示了医院和公共卫生在协调护理方面的结构性合作对于改善医疗保健质量和可及性的价值，因此可以作为解决 ADRD 少数种族和族裔人群差异的宏观机制。本文提出了一个概念框架，阐述了如何通过健康信息技术（HIT）系统成功实现护理协调，并最终解决 SRD 问题。因此，为了解决健康不平等问题，政策举措必须投资于 HIT 能力和基础设施，以促进护理协调，确定患者的需求和偏好，并促进患有 ADRD 的患者及其护理人员的参与。
