Published On February 25, 2016
A LANDMARK STUDY IN 2002 BY THE INSTITUTE OF MEDICINE outlined a bleak reality about U.S. hospitals: Minorities didn’t receive the same quality of care that white patients did. And while much has changed since then, much stays the same. A black patient, for instance, is still likely to get less pain medication than a white patient in the ER for appendicitis or a fractured arm or leg. And while black patients often need more care—African Americans have a greater incidence of cardiovascular disease, cancer, HIV/AIDS and diabetes than whites do—they often get less.
Partly in response to that report, Massachusetts General Hospital created the Disparities Solutions Center 10 years ago. Joseph Betancourt, director of the center, talks about what they’ve learned.
What kinds of disparities do African-American patients face?
The greatest disparities happen before the patient walks in the door. African Americans by and large have lower socioeconomic status than their white counterparts, live in communities with greater environmental hazards, and have less access to education. All of that affects your health.
And when they enter the hospital, they often get lower-quality care. Why?
There is no one suspect, just as there is no one solution. But communication problems are right on the fault line.
Research has consistently shown that minorities feel as if they have a harder time communicating with their caregivers. They report higher rates of not understanding their providers, and feeling like providers don’t listen to them.
There is also a persistent and well-recognized issue of mistrust. This is something that African-American patients have developed over time. If you consider the Tuskegee experiments, where black men were unknowingly made to suffer the curable effects of syphilis—the burden of that history can still affect the dynamic. So first, we need to work on better communication.
How do hospitals fix that?
There is a proven need to educate providers on what we call “cross-cultural communication.” There are two barriers to break down. You have to improve communication with patients of different cultural and ethnic backgrounds. But you also need to get better at translating between medical-speak and patient-speak.
We developed programs that show how to really have a valuable exchange with a patient. We teach how personal characteristics like race and ethnicity impact clinical decision-making, how to talk with someone from another culture, all of that. We’ve done this through the deployment of an e-learning tool, Quality Interactions. It has been used to train about 140,000 health care professionals across the country.
Has health care reform made things better?
Even after the Affordable Care Act, minorities are still more likely to be uninsured. Not having insurance makes it very, very difficult to get high-quality care in the ER, to manage chronic conditions and to get preventive care.
But now we’re moving from being paid for the quantity of health care we deliver to being paid for the quality of care we deliver. Hospitals are being held accountable for things like readmissions, patient experience and avoidable hospitalizations. We think better communication will help on all of those fronts. The business case and the social justice case to address disparities are coming together.
If a hospital wants to address racial inequality, what’s the first step?
Hospitals need to collect data and measure performance. That’s where the conversation begins. They have to know who their patients are and what type of care they are getting. So when patients register, hospitals should collect demographic information and then monitor their care based on a recommended set of treatments for each condition.
Every year here at Mass General, we look at a whole bunch of clinical quality metrics and we stratify them by race. This is the way we make sure that we are living up to our values. And if we find something, we do something.
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