Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
20 Cards in this Set
- Front
- Back
|
3 Fundamental differences that generate healthcare disparities
|
Quality of Health Care
Access to Health Care Human Populations |
|
|
Measures of Quality in Health care
|
Measures of Quality in Health Care
-Effectiveness (Outcomes) -Patient Safety -Timeliness -Patient Centeredness Factors that Confound Quality Measures -Underlying rates of illness -Genetic Variation -Local environmental conditions -Culture or Lifestyle |
|
|
Quality of Health care
|
Preventive Medicine
-Primary Care Physician Acute Treatment -Emergency Dept -Outpatient Clinic Chronic Disease Management -Primary Care Physician -Specialist |
|
|
Access to health care
|
Primary Care
Acute Medical Care -Emergency Dept -Outpatient Clinic -Hospital Long-Term Medical Care -Nursing Home -Palliative or End-of-Life Care |
|
|
Facilitators and barriers for access to health care
|
Care-seeking behavior
-Cultural beliefs and Linguistic barriers -Trust in healthcare providers -Predisposition to seek timely care (or delay) Availability of Care -Ability to pay (cash or insurance) -Location -Management and delivery of services -Health care practitioner beliefs Division of responsibility -Individual -Public sector vs Private sector |
|
|
Recommendations from IOM on disparities in healthcare
|
Raise public and provider awareness of disparities in care
Avoid health care plan fragmentation along socioeconomic lines Raise understanding of contribution of bias, stereotyping, prejudice, and clinical uncertainty Increase knowledge base on causes and interventions to reduce disparities Raise proportion of minorities among healthcare providers |
|
|
Prevalence of spirometry documented COPD
|
Women have less COPD than men
Mostly due to differences in smoking |
|
|
Prevalence of self reported COPD
|
Women have higher levels than men
Could be due to differences in reporting and/or who receives spirometry testing |
|
|
Smoking effects on FEV1 and COPD in women
|
Excess loss of FEV1 per amount smoked compared to men
Hospitalizations for COPD (RR=1.5-3.6) |
|
|
Quitting smoking effects in women and men
|
Women sustained quitters (SQ) gained more lung function than men in year 1
Women continued smokers (CS) lost more lung function than men |
|
|
COPD mortality by gender
|
As of 2000, women's COPD mortality surpassed men
|
|
|
Gender bias in diagnosis of COPD
|
Men more likely to be diagnosed with COPD than women with exact same complaints. Men also more likely to receive spirometry than women.
|
|
|
Gender bias in management of COPD
|
Women are more likely to report severe dyspnea
Women are more likely to receive smoking cessation counseling Women are less likely to be evaluated with spirometry |
|
|
COPD and women overview
|
Women are a tobacco marketing target
Women get more severe COPD than men when they smoke…but improve more after quitting Women feel worse than men Women are less likely to be quantitatively evaluated Women less likely to be prescribed therapy Women die more of COPD |
|
|
Lung cancer disparities
|
African Americans more likely to get lung cancer than whites
African Americans less likely to receive invasive staging African Americans and other races less likely to be offered surgery. Age and women also have disparities Surgery is not recommended for more AA with lung cancer than whites |
|
|
Asthma: morbidity, mortality, communication, literacy
|
African americans and puerto ricans have higher morbidity and mortality from asthma.
Poor communication among AA and physicians Literacy plays a role -Worse inhaler technique |
|
|
Asthma: environmental exposures
|
Indoor Allergens
-Cockroach, mold, rat, mouse exposure and sensitization -2-3x higher healthcare utilization Environmental Tobacco Smoke -48% Children with Elevated Cotinine Levels in the NCICAS* Nitrogen Dioxide* -24% Families Exposed to > 40 ppb in NCICAS -EPA limit = 50 ppb Ozone and Particulate Matter -Increased symptoms and medications Inner city residents have greatly increased risk of these exposures |
|
|
Salmeterol Trial
|
Increase in asthma related life threatening events and death when salmeterol (LABA) is used alone
Supposed to be used in addition to an ICS |
|
|
LABA drug treatment failure
|
African Americans failed 44% of time
Non-hispanic whites failed 25% of time |
|
|
Different degrees of African Ancestry
|
Lower levels of FEV1, even more so with increased African ancestry
|
