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Cultural Competency in Health Care

Cultural Competency in Health Care. Dr. Dorothy Dobbins Office of Cultural Affairs ETSU-Division of Health Sciences. QI Resident Training Project April 8, 2009. Learning Objectives . By the close of this session, you will be able to: Define cultural competency

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Cultural Competency in Health Care

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  1. Cultural Competency in Health Care Dr. Dorothy Dobbins Office of Cultural Affairs ETSU-Division of Health Sciences QI Resident Training Project April 8, 2009

  2. Learning Objectives • By the close of this session, you will be able to: • Define cultural competency • Understand the impact of culture on health outcomes, i.e. health disparities in general and of the region • Identify at least one model for enhancing cultural competency • Discuss and relate cultural competency to the development of quality improvement activities in clinics.

  3. Cultural Competency is: • That set of knowledge, skills, behaviors, attitudes, and level of self awareness that allows an individual to work effectively in cross cultural settings. Cultural Competency Framework

  4. Race Religion Nationality Region Culture Age the patterns of behavior and thinking that people living in social groups learn, create, and share. Ability Gender Sexual - Affectual

  5. Changing Demographics Table F. Population Change of Regions by Race and Hispanic Origin: 1995 to 2025 (In thousands.) _________________________________________________________________ Year Total ----------Non-Hispanic--------- and White Black American Asian Hispanic region Indian origin U.S. 72,295 15,594 11,920 812 11,970 31,999 Northeast 5,927 -2,074 1,495 32 2,319 4,155 Midwest 7,306 1,825 1,857 194 1,132 2,298 South 29,558 10,407 7,642 199 1,792 9,518 West 29,504 5,436 926 387 6,727 16,028 Source: U.S. Bureau of the Census, Population Division, PPL-47, Preferred Series, PPL-47, table 3.

  6. Health Disparities Specific population based differences in mortality and morbidity rates in diseases and treatment outcomes

  7. Disparities in Health Care • The Kaiser Family Foundation (2002) • National Survey of Physicians: Doctors on Disparities in Health Care • Institute of Medicine (2002) • Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care • The Commonwealth Fund (2002) • Minority Americans Lag Behind Whites on Nearly Every Measure of Health Care Quality

  8. Minority Populations are Disproportionately Affected • Cardiac disease • Diabetes • Infant mortality • HIV Infections/AIDS • Cancer screening and management • Immunizations

  9. Health Disparities http://www.ahrq.gov/qual/nhqr05/Index.html http://www.ahrq.gov/qual/nhqr05/safety/T2-38.htm The 2007 National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States.

  10. Appalachian Experience

  11. “The Eight Americas” Where You Live Is Linked to Life Expectancy Source: Investigation of Morality Disparities across Races, Counties, and Race-Counties in the US (1982-2001), Murray et. Al., 2006

  12. Northland L-I Rural Whites Asians High Risk Urban Blacks Middle America L-I Southern Rural Blacks L-I Whites Appalachia/ MS Valley Black Middle America Western Native Americans

  13. Gender, Race and Age Segments Specific Percent of Excess Mortality Rates in the Appalachian Region Compared to Total US Rates by Cause of Death, 1990-1997 Halverson, J.A., Ma, L., and Harner, E.J. (2004). An analysis of disparities in health status and access to health care in the Appalachian region. Washington DC: Appalachian Regional Commission.

  14. Kaiser National Survey of Physicians

  15. Department of Family Medicine AETNA FOUNDATION AETNA 2001 QUALITY CARE RESEARCH FUND Project Title: "Assessing the Impact of Cultural Competency Training Using Participatory Quality Improvement Methods” Project Period: January 1, 2002 - December 31, 2003 Grantee: Center for Healthy Families and Cultural Diversity - Department of Family Medicine University of Medicine and Dentistry of New Jersey (UMDNJ) – Robert Wood Johnson Medical School Authors: Robert C. Like, MD, MS, Principal Investigator; Fulcomer, Kairys, Wathington, BA Jesse Crosson, PhD

  16. Awareness Behaviors

  17. Respect: A Cultural Competence Model RESPECT! • Awareness (as a deliberate thought process) is an important first step in becoming culturally competent as an individual and an organization. • Beyond gaining awareness, knowledge and skills, fundamentally cultural competency, whether at the individual or organizational level, must be about • Above all, people, clients and organizations should be engaged in ways that provide: • R – Rapport • E – Empathy • S – Support • P – Partnerships • E – Explanations • C – Cultural • T – Trust Source: Mutha, 2002

  18. Beyond the Vital Signs What are some challenges you have faced with understanding the beliefs and/or practices of patients? What are some institutional policies that have limited your ability to treat your patient as an individual? What skills/behaviors did you note that appeared to be effective in handling cultural sensitive situations? Did the film suggest any cultural competency training for your residents that could improve the quality of patient care?

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