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Workshop
B-6: How cultural competencey contributes to reducing racial/ethnic disparaties
in healthcare
Pulling Up
the Roots of Inequality: How Culturally Competency Contributes to Reducing
Racial/Ethnic Disparities in Healthcare
This panel session will present state-of-the-art research on how culturally
competent care can contribute to reducing racial/ethnic disparities in
healthcare. Participants can expect to learn about innovative studies
or models that document or conceptualize how reduction or elimination
of racial/ethnic disparities in healthcare can be achieved through delivery
of culturally competent care.
Discussants
Glenn
Flores, MD, FAAP
Dr. Flores is Associate Professor (with tenure) of Pediatrics, Epidemiology
and Health Policy at the Medical College of Wisconsin. He is also Director
of Community Outcomes and Associate Director of the Center for the Advancement
of Urban Children in the Department of Pediatrics at the Medical College
of Wisconsin and Children’s Hospital of Wisconsin. He founded and
is the former Co-Director of the Pediatric Latino Clinic at Boston Medical
Center. He is a Robert Wood Johnson Generalist Physician Faculty Scholar
and a former Robert Wood Johnson Minority Medical Faculty Scholar. He
has published over 50 articles and book chapters on a variety of topics,
including “Errors in medical interpretation and their potential clinical
consequences in pediatric encounters (Pediatrics 2003;111:6-14.),
and “The health of Latino children: Urgent priorities, unanswered
questions, and a research agenda” (Journal of the American Medical
Association 2002;288:82-90).
Dr. Flores’s current research includes an investigation of medical
interpreter errors and their clinical consequences (funded by the Office
of Minority Health), studies of innovative interventions for insuring
uninsured children (funded by the Agency for Healthcare Research and Quality,
the Center for Medicare and Medicaid Services, and the Robert Wood Johnson
Foundation), and a randomized trial of the effectiveness of parent mentors
in improving childhood asthma outcomes (supported by the Commonwealth
Fund and the Robert Wood Johnson Foundation).
Glenn Flores, MD
Center for the Advancement of Urban Children
Department of Pediatrics
Medical College of Wisconsin
8701 Watertown Plank Rd.
Milwaukee, WI 53226
Phone: 414.456.8273
gflores@mail.mcw.edu
Joseph R. Betancourt, M.D., M.P.H.
Dr. Betancourt’s primary interests include cross-cultural medicine,
minority recruitment into the health professions, and minority health/health
policy research. He has served as Principal Investigator on grants from
the Center for Medicare and Medicaid Services and the Commonwealth Fund,
and is currently Principal Investigator on projects funded by the California
Endowment, the Commonwealth fund, in addition to being co-investigator
on a project funded by the National Cancer Institute and the Health Resources
and Services Administration. Dr. Betancourt has served on several Institute
of Medicine (IOM) Committees, including those that produced “Unequal
Treatment: Confronting Racial/Ethnic Disparities in Health Care”,
“Guidance for a National Health Care Disparities Report”,
and “In the Nation’s Compelling Interest: Ensuring Diversity
in the Health Care Workforce.” He also sat on the Physician’s
for Human Rights Blue Ribbon Panel on Racial/Ethnic Disparities in Health.
Dr. Betancourt served on the CDC’s National Expert Council for the
Diabetes Today Program, and currently Co-Chairs the MGH Disparities Committee.
He is also reviewer for the American Medical Association’s Journal
Consortium and Annals of Internal Medicine. Dr. Betancourt has written
peer-reviewed articles on topics including racial/ethnic disparities in
health and health care; hypertension, diabetes, and cerebrovascular disease
in minority communities; cross-cultural care and education; ethics; workforce
diversity; and the impact of language barriers on health care. Dr. Betancourt
also teaches cross-cultural medicine, health disparities, and health policy
to medical students and residents at MGH-Harvard Medical School and to
students at the Harvard School of Public Health.
Joseph Betancourt, M.D., M.P.H.
Senior Scientist, Institute for Health Policy
Program Director for Multicultural Education
Massachusetts General Hospital
Assistant Professor of Medicine,
Harvard Medical School
Institute for Health Policy
Massachusetts General Hospital/Partners
50 Staniford Street, Rm 942
Boston, MA 02114
(617) 724-9713
jbetancourt@pol.net
Panelists:
Speaker 1
Eboni G. Price, MD, MPH, Johns Hopkins University School of Medicine.
"Cultural Competence Training of Health Professionals to Improve
Minority Healthcare Quality: A Systematic Review of the Literature"
In 2003, the Institute of Medicine report Unequal Treatment identified
cultural competence training of health professionals as a potential strategy
to improve quality of care and to reduce health disparities between ethnic
minorities and whites. A recent systematic review of cultural competence
training interventions targeted at health care providers and designed
to improve minority health identified good evidence that cultural competence
training impacts provider knowledge, attitude and skills. However, few
studies assessed patient outcomes. Dr. Price will present the results
this review: (1) highlighting the methodological strengths and weakness
of the studies with respect to the design, analyzing and reporting of
results, (2) describing an example of current research in this area which
addresses these methodological issues, and (3) describing the gaps in
the current evidence base upon which future research of cultural competence
training as a strategy to improve minority healthcare quality might be
based.
Eboni G. Price, MD, MPH
Dr. Price is a third year fellow in the Academic General Internal Medicine
Fellowship Program (Clinician Educator Track) at Johns Hopkins University
School of Medicine. She is a Senior Clinical Fellow at Johns Hopkins Hospital,
Johns Hopkins Bayview Medical Center and Johns Hopkins Community Physicians.
She received her Bachelor of Science from the University of Notre Dame,
and her medical degree from Johns Hopkins University School of Medicine.
She completed her residency training in Internal Medicine at Baylor College
of Medicine. She also completed training in public health (MPH) at the
Johns Hopkins Bloomberg School of Public Health.
Dr. Price’s academic interests include doctor-patient communication,
cultural competence training of health professionals, and minority health
disparities. As an advocate for best evidence medical education, she has
focused her fellowship training in curriculum development, implementation,
and evaluation through educational research targeted at medical students
and Internal Medicine residents in these topic areas. She is a co-developer
and co-Director of a second year medical student course which combines
training in communication skills and clinical reasoning and emphasizes
the biopsychosocial approach to medical interviewing. She is also a co-developer
of curriculum targeted at Internal Medicine residents and designed to
teach them how to discuss end-of-life care in a culturally sensitive manner.
Dr. Price has worked with the Johns Hopkins Evidence Based Practice
Center to conduct a systematic review of cultural competence interventions
designed to improve minority health for the Agency for Healthcare Research
and Quality. As a member of the Johns Hopkins University Department of
Medicine Diversity Council, she conducted a qualitative assessment of
faculty perceptions of the role of the diversity climate in the recruitment,
promotion and retention of faculty in academic medicine. She is currently
conducting a survey of diverse groups of physicians to assess career development
issues, experiences of bias in the workplace, and professional satisfaction
in an academic medical setting.
Dr. Price is a member of the American Medical Association, Society of
General Internal Medicine, American College of Physicians, and the American
Academy on Physician and Patient.
Eboni G. Price, MD, MPH
Division of General Internal Medicine
Johns Hopkins University School of Medicine
2024 East Monument Street, Suite 2-516
Baltimore, MD 21287
Phone: (410) 502-8895
eprice3@jhmi.edu
Speaker 2
Elizabeth Jacobs, MD MPP, Cook County Hospital & Rush Medical
College. “A Community-Based Teaching Program to Help Resident Physicians
Understand How the Context of Patients' Lives Affects Health and Access
Health Care."
Racial and ethnic disparities in health care continue to be a major
impediment to improving the public health of many communities in the United
States. Efforts to improve the health of these communities and their members
must be directed at the multiple social, economic and historic determinants
of these disparities. Health care providers must also be aware of these
determinants and have the tools to be able to address them in their individual
relationships with patients. In this presentation, Dr. Jacobs will describe
a unique educational intervention and partnership that arose out of the
mutual recognition by a community organization and public hospital of
the need to teach physicians these skills. The curriculum is co-taught
by physicians and community members in the hospital and community setting
and has had positive impact on the participating physicians and community
members as well as the community as a whole.
Dr. Jacobs is a Clinician-researcher and Assistant Professor of Medicine
at Cook County Hospital and Rush Medical College. She attended medical
school at University of California at San Francisco, trained as a general
internist at Brigham and Women’s Hospital in Boston, and completed
a Robert Wood Johnson Clinical Scholars Fellowship at the University of
Chicago. After struggling to care for limited English-speaking patients
during medical school and residency, she decided to pursue a research
career investigating minority disparities in health care. As a RWJ fellow,
she completed a project that demonstrated that adequate interpreter services
can reduce disparities in delivery of health care between English and
non-English speaking persons. She has recently expanded this study to
investigate the balance of costs and benefits of providing interpreter
services. She joined the faculty of the Collaborative Research Unit of
Cook County Hospital, one of the largest public hospitals in the country,
in September of 1998 to pursue similar research. Her research interests
also include access to, and cultural specificity of, medical care delivered
to minority patients and she recently received as grant to conduct a five
year study measuring the relationship between general trust in physicians
and health care institutions and cancer screening among African-American
women. In addition, she cares for patients at in the general medicine
clinic and breast clinic, works with other investigators to design culturally
specific research, and teaches residents and faculty about practicing
culturally sensitive medicine and about the use of race and ethnicity
variables in research.
Elizabeth Jacobs, MD MPP
Assistant Professor of Medicine
Collaborative Research Unit
Cook County Hospital & Rush Medical College
1900 W Polk Street, 16th Floor
Chicago, IL 60612
Phone: 312-864-7311
Fax: 312-864-9694
Pager: 312-333-4209
Speaker 3
Somnath Saha, MD, MPH, Portland VA Medical Center. "Diversity
as a Means to a More Culturally Competent Workforce."
Increasing the diversity of the health professions workforce is commonly
cited as an essential component of efforts to increase cultural competence
in the U.S. health care system and to reduce racial/ethnic disparities
in the quality of health care. Programs promoting diversity, however,
have become vulnerable in the current political climate. Sustaining such
programs will increasingly require documented evidence of their benefits.
We will present findings from a review of current evidence related to
the benefits of a more diverse health care workforce, including studies
of practice patterns and locations of minority health professionals; how
race and ethnicity affect patient-provider relationships; and the influence
of minority leaders on health care practice, policies, and education.
We will also identify gaps in the current evidence base that represent
important areas for future research.
Dr. Saha attended medical school and trained in internal medicine
at the University of California, San Francisco. He completed fellowship
training in the Robert Wood Johnson Clinical Scholars Program at the University
of Washington in Seattle. He currently works as a general internist at
the Portland VA Medical Center and is an Assistant Professor of Medicine
and Medical Informatics & Outcomes Research at Oregon Health &
Science University. Dr. Saha’s primary research interests are in
understanding causes of racial and ethnic disparities in health care,
and particularly in the potential impact of increasing workforce diversity
and cultural competence among physicians in reducing disparities. He received
a career development award, to pursue this research, from the Health Services
Research and Development Service of the Department of Veterans Affairs,
and served on the VA’s National Ethics Committee Task Force on Ethnic
Disparities in Health Care. He is also a member of the Disparities Task
Force of the Society of General Internal Medicine and the recipient of
a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar
award.
Somnath Saha, MD, MPH
Staff Physician, Portland VAMC
Assistant Professor of Medicine, OHSU
Portland VAMC (P3MED)
3710 SW U.S. Veterans Hospital Rd.
Portland, OR 97239
Phone: 503-220-8262 ext 55418
Fax: 503-721-7807
sahas@ohsu.edu
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