解决慢性病健康与医疗保健方面种族和族裔差异的策略：2017年至2024年研究证据图谱
Strategies to Address Racial and Ethnic Disparities in Health and Health Care for Chronic Conditions : An Evidence Map of Research From 2017 to 2024.
作者信息
Lamina Toyin, Abdi Hamdi I, Behrens Kathryn, Parikh Romil, Call Kathleen, Claussen Amy M, Dill Janette, Grande Stuart W, Houghtaling Laura, Jones-Webb Rhonda, Nkimbeng Manka, Rogers Elizabeth A, Sultan Shahnaz, Widome Rachel, Wilt Timothy J, Butler Mary
机构信息
Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota (T.L., H.I.A., K.B., R.P., K.C., A.M.C., J.D., S.W.G., L.H., R.J., M.N., M.B.).
Division of General Internal Medicine, Medical School, University of Minnesota, Minneapolis, Minnesota (E.A.R.).
出版信息
Ann Intern Med. 2025 Jan;178(1):88-97. doi: 10.7326/ANNALS-24-01262. Epub 2024 Dec 17.
BACKGROUND
Racial and ethnic disparities in health and health care persist in the United States, adversely affecting outcomes in prevention and treatment of chronic conditions among adults.
PURPOSE
To map interventions aimed at reducing racial and ethnic disparities and improving health outcomes in the prevention and treatment of chronic conditions in adults.
DATA SOURCES
Searches of MEDLINE, CINAHL, and Scopus from January 2017 to April 2024, supplemented with gray literature.
STUDY SELECTION
U.S.-based studies of interventions targeting racial and ethnic disparities in adults with chronic conditions.
DATA EXTRACTION
Information on intervention types, targets, outcomes, study designs, study settings, chronic conditions, and delivery personnel was extracted and categorized.
DATA SYNTHESIS
Among 174 unique studies, 12 intervention types were identified, with self-management support and patient navigation the most common. Most interventions targeted patient behaviors; few studies addressed disparities directly or focused on underrepresented racial and ethnic marginalized groups.
LIMITATIONS
The lack of standardized terminology and the underrepresentation of certain racial and ethnic groups limit the evidence base. Although the literature search accurately reflects the current state of the literature, it also limits the body of evidence by excluding health disparities research conducted before January 2017, so significant findings from earlier studies may have been overlooked.
CONCLUSION
The literature highlights diverse interventions targeting health disparities, but few studies evaluated their effectiveness in reducing the health disparities gaps. There is an urgent need for research focused on underrepresented racial and ethnic groups, particularly in promising areas such as patient navigation for cancer and diabetes self-management. Future research should prioritize robust study designs to assess the long-term effect and broader applicability of interventions, thus helping organizations and stakeholders to tailor strategies to community-specific needs.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
背景
美国在健康和医疗保健方面的种族和族裔差异依然存在，对成年人慢性病的预防和治疗结果产生不利影响。
目的
梳理旨在减少种族和族裔差异并改善成年人慢性病预防和治疗健康结果的干预措施。
数据来源
检索2017年1月至2024年4月的MEDLINE、CINAHL和Scopus数据库，并辅以灰色文献。
研究选择
针对美国成年人慢性病中种族和族裔差异的干预措施研究。
数据提取
提取并分类关于干预类型、目标、结果、研究设计、研究环境、慢性病和实施人员的信息。
数据综合
在174项独特研究中，确定了12种干预类型，其中自我管理支持和患者导航最为常见。大多数干预措施针对患者行为；很少有研究直接解决差异问题或关注代表性不足的种族和族裔边缘化群体。
局限性
缺乏标准化术语以及某些种族和族裔群体代表性不足限制了证据基础。尽管文献检索准确反映了当前文献状况，但通过排除2017年1月之前进行的健康差异研究也限制了证据范围，因此早期研究的重要发现可能被忽视。
结论
文献强调了针对健康差异的多种干预措施，但很少有研究评估它们在缩小健康差异差距方面的有效性。迫切需要针对代表性不足的种族和族裔群体开展研究，特别是在癌症患者导航和糖尿病自我管理等有前景的领域。未来研究应优先采用强有力的研究设计来评估干预措施的长期效果和更广泛的适用性，从而帮助组织和利益相关者根据社区特定需求调整策略。
主要资金来源
医疗保健研究与质量局。
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