Cultural Health Capital

2016 ◽  
Author(s):  
Janet K. Shim ◽  
Jamie Suki Chang ◽  
Leslie A. Dubbin
Keyword(s):  
Health Care ◽  
Underserved Populations ◽  
Primary Source ◽  
The United States ◽  
Cultural Resources ◽  
Health Capital ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Patient Protection ◽  
Centered Care

The 2010 Patient Protection and Affordable Care Act promulgated a number of fundamental changes to the United States health-care system. Less visible and controversial aspects included the creation of institutions and strategies to reduce health disparities and enhance the quality and patient-centeredness of health care. In this chapter, we offer the concept of cultural health capital (CHC) as a sociological intervention for analyzing these changes aimed at making health care more patient-centered, particularly for historically underserved populations. In particular, we use the notion of CHC to illustrate how patient-centered care is accomplished or undone through complex interpersonal and interactional work that is highly dependent on access to stratified cultural resources that both patients and providers bring to health-care interactions. In so doing, we aim to contest that racism in health care is the primary source of health inequalities. Instead we argue that patients’ and providers’ cultural assets and interactional styles—themselves the product of complex social, cultural, historical, political, and economic contexts—influence their abilities to communicate with and understand one another.

scholarly journals A Brief Survey on Six Basic and Reduced eHealth Indicators in Seven Countries in 2017

2018 ◽  
Vol 09 (03) ◽  
pp. 704-713 ◽  
Author(s):  
Reinhold Haux ◽  
Elske Ammenwerth ◽  
Sabine Koch ◽  
Christoph Lehmann ◽  
Hyeoun-Ae Park ◽  
...  
Keyword(s):  
Health Care ◽  
Information Processing ◽  
Health Care Professionals ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Political Will ◽  
Record Data ◽  
Centered Care ◽  
Future Work

Background Holistic, ubiquitous support of patient-centered health care (eHealth) at all health care institutions and in patients' homes through information processing is increasingly supplementing institution-centered care. While eHealth indicators may measure the transition from institution-centered (e.g., hospital-centered) information processing to patient-centered information processing, collecting relevant and timely data for such indicators has been difficult. Objectives This article aims to design some basic eHealth indicators, which are easily collected and measure how well information processing supports holistic patient-centered health care, and to evaluate penetrance of patient-centered health as measured by the indicators internationally via an expert survey. Methods We identified six basic indicators that measure access of health care professionals, patients, and caregivers to the patient's health record data and the ability of providers, patients, and caregivers to add information in the patient's record. In a survey of international informatics experts, these indicators' penetrance were evaluated for Austria, Finland, Germany, Hong Kong, South Korea, Sweden, and the United States in the summer of 2017. Results The eHealth status measured by the indicators varied significantly between these seven countries. In Finland, most practices measured by the indicators were fully implemented whereas in Germany only one practice was partially realized. Conclusion Progress in the implementation of practices that support patient-centered care could mainly be observed in those countries where the “political will” focused on achieving patient-centered care as opposed to an emphasis on institution-centered care. The six eHealth indicators seem to be useful for measuring national progress in patient-centered care. Future work will extend the number of countries analyzed.

Neurosurgical practice and health care reform: moving toward quality-based health care delivery

2013 ◽  
Vol 34 (1) ◽  
pp. E1 ◽  
Author(s):  
Rachel F. Groman ◽  
Koryn Y. Rubin
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Physician Patient Relationship ◽  
Patient Centered ◽  
Patient Protection ◽  
The Us ◽  
Us Government ◽  
Centered Care ◽  
The Cost

In an effort to rein in spending and improve patient outcomes, the US government and the private sector have adopted a number of policies over the last decade that hold health care professionals increasingly accountable for the cost and quality of the care they provide. A major driver of these efforts is the Patient Protection and Affordable Care Act of 2010 (ACA or Pub.L. 111–148), which aims to change the US health care system from one that rewards quantity to one that rewards better value through the use of performance measurement. However, for this strategy to succeed in raising the bar on quality and efficiency, it will require the development of more standardized and accurate methods of data collection and further streamlined federal regulations that encourage enhanced patient-centered care instead of creating additional burdens that interfere with the physician-patient relationship.

scholarly journals Disparities in Access to Oral Health Care

2020 ◽  
Vol 41 (1) ◽  
pp. 513-535 ◽  
Author(s):  
Mary E. Northridge ◽  
Anjali Kumar ◽  
Raghbir Kaur
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Low Income ◽  
Safety Net ◽  
The United States ◽  
Oral Health Care ◽  
Oral Diseases ◽  
Patient Centered ◽  
Obesity And Diabetes ◽  
Centered Care

In the United States, people are more likely to have poor oral health if they are low-income, uninsured, and/or members of racial/ethnic minority, immigrant, or rural populations who have suboptimal access to quality oral health care. As a result, poor oral health serves as the national symbol of social inequality. There is increasing recognition among those in public health that oral diseases such as dental caries and periodontal disease and general health conditions such as obesity and diabetes are closely linked by sharing common risk factors, including excess sugar consumption and tobacco use, as well as underlying infection and inflammatory pathways. Hence, efforts to integrate oral health and primary health care, incorporate interventions at multiple levels to improve access to and quality of services, and create health care teams that provide patient-centered care in both safety net clinics and community settings may narrow the gaps in access to oral health care across the life course.

“We’re a Little Biased”: Medicine and the Management of Bias through the Case of Contraception

2021 ◽  
pp. 002214652110032
Author(s):  
Jamie L. Manzer ◽  
Ann V. Bell
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Contraceptive Use ◽  
Management Strategies ◽  
The United States ◽  
Care Providers ◽  
Patient Counseling ◽  
Patient Centered ◽  
American Health Care System ◽  
Centered Care

There is a wealth of literature demonstrating the presence of bias throughout the American health care system. Despite acknowledging such presence, however, little is known about how bias functions within medical encounters, particularly how providers grapple with bias in their patient counseling and decision-making. We explore such processes through the case of contraceptive counseling, a highly raced, classed, and gendered context. In-depth interviews with 51 health care providers reveal that providers use four primary strategies to navigate and minimize bias in their care—using scientific rationale, employing “safe” biases, standardizing counseling, and implementing patient-centered care. Paradoxically, using these strategies can exacerbate rather than resolve bias. Understanding these bias management strategies reveals provider-held biases, how they manifest within appointments, and the potential consequences for patients’ health autonomy. Such knowledge informs interventions that promote contraceptive use among women in the United States, addresses bias in health care broadly, and thus ultimately helps combat health disparities.

scholarly journals Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study (Preprint)

2019 ◽  
Author(s):  
Aleida Gerarda Huppelschoten ◽  
Jan Peter de Bruin ◽  
Jan AM Kremer
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Pilot Study ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Web Based ◽  
Online Platform ◽  
Centered Care

BACKGROUND Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. OBJECTIVE The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. METHODS This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. RESULTS Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. CONCLUSIONS Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care.

scholarly journals The Financial And Cost Accounting Implications Of The Increased Role Of Advanced Nurse Practitioners In U.S. Healthcare

2011 ◽  
Vol 2 (2) ◽  
pp. 1-8
Author(s):  
Paul J. Carruth ◽  
Ann K. Carruth
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Nurse Practitioners ◽  
Healthcare Reform ◽  
Cost Effective ◽  
The United States ◽  
Highly Qualified ◽  
Patient Centered ◽  
Wide Range ◽  
Centered Care

On March 23, 2010, the Affordable Care Act became law. The need for healthcare reform was prompted by an imperative to reduce the relentless increase in spending on medical care in the United States. One approach to examining and solving the problem of escalating costs is to focus on applying proven principles of evidence-based practice and cost-effectiveness practices to find the least-expensive way to ensure clinical services of acceptable quality without sacrificing patient satisfaction. Advanced practice registered nurses (APRNs) have positioned themselves to serve an integral role in national health care reform. A successful transformation of the nation's health system will require utilization of all clinicians, including highly qualified APRNs, to provide cost- effective, accessible, patient-centered care. There is extensive, consistent evidence that nurse practitioners (NPs) provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals. However, current policies in many states prevent NPs from practicing within their full, legally defined scopes of practice. The Office of Technology Assessment's conclusions noted in 1981 that APRNs can be substituted for physicians in a significant portion of medical services with at least similar outcomes. Since then, numerous studies have supported that the care provided is equal to those provided by physicians for services within the overlapping scopes of licensed practice. This paper combines economic analysis with review of literature on health care reform initiatives to explore how the goals of healthcare reform can be accomplished by advanced nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings. 

scholarly journals Patient centeredness: The perspectives of uninsured primary care patients in the United States

2019 ◽  
Vol 22 (1) ◽  
pp. 19-26 ◽  
Author(s):  
Akiko Kamimura ◽  
Shannon Weaver ◽  
Bianca Armenta ◽  
Bethany Gull ◽  
Jeanie Ashby
Keyword(s):  
United States ◽  
Primary Care ◽  
Health Outcomes ◽  
Patient Involvement ◽  
The United States ◽  
Patient Centered Care ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
Primary Care Patients

Introduction Patient-centered care has become increasingly important within the United States (US) healthcare system. Given that patient-centered care predicts patient satisfaction, health outcomes, and cost-effectiveness, it is of the utmost importance to study patient-centered care from the perspectives of marginalized populations including minorities, immigrants, and other underserved populations. The purpose of this study is to examine factors that affect underserved primary care patients’ perceptions of patient centeredness. Methods The data were cross-sectional and collected in Fall 2016. Free clinic patients (N = 723) completed a self-administered survey, which measures patient centeredness, patient involvement in care, and clinical empathy. Validated measures were part of the survey, and the internal consistency of scales was tested. The general linear model was performed to predict factors associated with patients’ perceptions of patient centeredness. Results Higher levels of perceived patient involvement in care and higher levels of perceived empathy in consultation are related to higher levels of patient centeredness. While better physical health is associated with higher levels of perceived empathy in consultation, high levels of emotional health and depression are not. Conclusions Patients’ perceptions of involvement and empathy are important factors for patient-centered care, although this study did not show causal directions among variables. Based on the findings of this study, it is recommended that future studies should focus on the following three points: (1) to develop and evaluate trainings for providers, (2) develop education classes for patients who utilize free clinics, (3) analyze how these programs affect patient-centered care and health outcomes.

scholarly journals The Impact of Applying Quality Management Practices on Patient Centeredness in Jordanian Public Hospitals: Results of Predictive Modeling

2018 ◽  
Vol 55 ◽  
pp. 004695801875473 ◽  
Author(s):  
Heba H. Hijazi ◽  
Heather L. Harvey ◽  
Mohammad S. Alyahya ◽  
Hussam A. Alshraideh ◽  
Rabah M. Al abdi ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Management Practices ◽  
Patient Centered Care ◽  
Accreditation Process ◽  
Public Hospitals ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Centered Care ◽  
The Impact

Targeting the patient’s needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital’s engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses’ perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital’s agenda as a strategy for continuous quality improvement.

scholarly journals More Than Numbers: Discourses of Health Care Quality in Finland

SAGE Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 215824402098001
Author(s):  
Tiina J. Peltola ◽  
Hanna Tiirinki
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
Patient Centered Care ◽  
Patient Reported Outcome Measures ◽  
Care Quality ◽  
Structured Interviews ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care

Finnish institute for health and welfare is developing national health care quality registers for the ongoing project in 2018–2020, which covers seven disease pilot registers. This article describes professionals’ and patient associations’ cultural health care quality conceptions at developing process, reflecting to Weick’s sensemaking theory and patient-centered care. Research data ( N = 13) were collected by individual thematic semi-structured interviews from pilot registers’ professionals and patient associations. Data were analyzed using the discursive approach. Six main discourses on the shared sociocultural meanings of health care quality were constructed: confidence and reliability, information and understanding, safety and medical effectiveness, support, benchmarking and utility, and requirement and justice. Health care quality is built-in culture and action to achieve patient-centered care and is complex to define. Patient–clinician interaction, understanding, and support are constructive elements to make sense of quality registers’ necessity and data collection. The importance of Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) measures is recognized to strengthen the patient-centeredness, which reflects to all health care decision-making, processes, and care. The data publication should be designed clearly and visually versatile. The study can offer new aspects for selecting valid quality indicators to produce comprehensive information for health care quality registers.

scholarly journals Identifying Successful Practices to Overcome Access to Care Challenges in Community Health Centers

2018 ◽  
Vol 5 ◽  
pp. 233339281774340 ◽  
Author(s):  
Tammy Toscos ◽  
Maria Carpenter ◽  
Mindy Flanagan ◽  
Kislaya Kunjan ◽  
Bradley N. Doebbeling
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Community Health ◽  
Health Care Access ◽  
Underserved Populations ◽  
The United States ◽  
Patient Centered ◽  
Clinic Staff ◽  
Care Access ◽  
Improve Access

Background: Despite health care access challenges among underserved populations, patients, providers, and staff at community health clinics (CHCs) have developed practices to overcome limited access. These “positive deviant” practices translate into organizational policies to improve health care access and patient experience. Objective: To identify effective practices to improve access to health care for low-income, uninsured or underinsured, and minority adults and their families. Participants: Seven CHC systems, involving over 40 clinics, distributed across one midwestern state in the United States. Methods: Ninety-two key informants, comprised of CHC patients (42%) and clinic staff (53%), participated in semi-structured interviews. Interview transcripts were subjected to thematic analysis to identify patient-centered solutions for managing access challenges to primary care for underserved populations. Transcripts were coded using qualitative analytic software. Results: Practices to improve access to care included addressing illiteracy and low health literacy, identifying cost-effective resources, expanding care offerings, enhancing the patient–provider relationship, and cultivating a culture of teamwork and customer service. Helping patients find the least expensive options for transportation, insurance, and medication was the most compelling patient-centered strategy. Appointment reminders and confirmation of patient plans for transportation to appointments reduced no-show rates. Conclusion: We identified nearly 35 practices for improving health care access. These were all patient-centric, uncovered by both clinic staff and patients who had successfully navigated the health care system to improve access.

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