Cultural Competency in Health Care

Dr. Dorothy DobbinsOffice of Cultural Affairs

ETSU-Division of Health Sciences

QI Resident Training ProjectApril 8, 2009

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 competencyDiscuss and relate cultural competency to the development of quality improvement activities in clinics.

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

Culturethe patterns of behavior and thinking that people living in social groups learn, create,

and share.

Race

Nationality

Age

Gender

Sexual - Affectual

Ability

Region

Religion

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.

Health Disparities

Specific population based differences in mortality and morbidity rates in diseases

and treatment outcomes

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

              

  

              

  

              

  

• Cardiac disease

• Diabetes

• Infant mortality

• HIV Infections/AIDS

• Cancer screening and management

• Immunizations

Minority Populations are Disproportionately Affected

http://www.ahrq.gov/qual/nhqr05/safety/T2-38.htm

Health Disparities

The 2007 National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States.

http://www.ahrq.gov/qual/nhqr05/Index.html

“The Eight Americas”

Source: Investigation of Morality Disparities across Races, Counties, and Race-Counties in the US (1982-2001), Murray et. Al., 2006

Where You Live Is Linked to Life Expectancy

AsiansNorthland L-I Rural Whites

Middle America

L-I Whites Appalachia/ MS ValleyWestern Native AmericansBlack

Middle

America

L-I Southern

Rural

Blacks

High

Risk

Urban

Blacks

Gender, Race and Age Segments Specific Percent of Excess Mortality Rates in the Appalachian Region Compared to Total

US Rates by Cause of Death, 1990-1997Cause of Death Premature Mortality 35-64 Elderly Mortality age 65+

WhiteMale

WhiteFemale

BlackMale

BlackFemale

WhiteMale

WhiteFemale

BlackMale

BlackFemale

Heart disease 27.4% 29.8 9.0 12.2 10.9 11.6 1.3 -5.7

Cancers 12.2 3.0 3.0 -2.1 5.0 -2.1 -2.3 -4.9

Stroke 17.9 14.5 15.7 13.8 5.0 3.9 .8 .9

Lung Cancer 27.7 2.7 4.2 -3.7 13.8 -8.3 -3.4 -11.8

Accidental deaths -1.5 -2.0 2.4 3.0 16.9 10.2 10.3 12.5

COPD 6.6 9.2 14.9 16.9 11.9 -.7 6.0 -1.0

Diabetes 14.8 22.4 10.7 20.5 3.6 23.0 -3.5 1.2

Motor Vehicle Accidents

25.8 23.3 23.4 19.1 21.1 13.7 21.3 5.7

Halverson, J.A., Ma, L., and Harner, E.J. (2004). An analysis of disparities in health status and accessto health care in the Appalachian region. Washington DC: Appalachian Regional Commission.

Kaiser National Survey of Physicians

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

Awareness

Behaviors

RESPECT: A Cultural Competence Model 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

RESPECT!

Source: Mutha, 2002

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?