Integrating racially and ethnically diverse communities into planning for disasters: the California experience.

Objectives: Racially/ethnically diverse communities suffer a disproportionate burden of adverse outcomes before, during and after a disaster. Using California as a locus of study, we sought to identify challenges and barriers to meeting the preparedness needs of these communities and highlight promising strategies, gaps in programs, and future priorities.

Methods: We conducted a literature review, environmental scan of organizational Web sites providing preparedness materials for diverse communities, and key informant interviews with public health and emergency management professionals.

Health reform holds both risks and rewards for safety-net providers and racially and ethnically diverse patients.

The Affordable Care Act of 2010 creates both opportunities and risks for safety-net providers in caring for low-income, diverse patients. New funding for health centers; support for coordinated, patient-centered care; and expansion of the primary care workforce are some of the opportunities that potentially strengthen the safety net. However, declining payments to safety-net hospitals, existing financial hardships, and shifts in the health care marketplace may intensify competition, thwart the ability to innovate, and endanger the financial viability of safety-net providers.

Integrating literacy, culture, and language to improve health care quality for diverse populations.

Objective: To understand the interrelationship of literacy, culture, and language and the importance of addressing their intersection.

Methods: Health literacy, cultural competence, and linguistic competence strategies to quality improvement were analyzed.

Results: Strategies to improve health literacy for low-literate individuals are distinct from strategies for culturally diverse and individuals with limited English proficiency (LEP).

Preparing racially and ethnically diverse communities for public health emergencies.

The tragedy of Hurricane Katrina in New Orleans confirmed that effective implementation of public health preparedness programs and policies will require compliance from all racial and ethnic populations. This study reviews current resources and limitations and suggests future directions for integrating diverse communities into related strategies. It documents research and interventions, including promising models and practices that address preparedness for minorities.

The changing landscape of hospital capacity in large cities and suburbs: implications for the safety net in metropolitan America.

An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cities and their suburbs for the years 1996, 1999, and 2002, we examined a number of measures of use and capacity, including staffed beds, admissions, outpatient and emergency department visits, trauma centers, and positron emission tomography scanners. Over the 6-year period, the number of for-profit, nonprofit, and public hospitals declined in both cities and suburbs, with public hospitals showing the largest percentage of decreases.

Measuring progress in meeting healthy people goals for low birth weight and infant mortality among the 100 largest cities and their suburbs.

We examined the progress of the nation's 100 largest cities and their surrounding suburban areas toward achieving Healthy People 2000/2010 goals for two measures of infant health: low birth weight (LBW) and infant mortality (IM). Using data from the National Center for Health Statistics, we compared 1990 and 2000 urban and suburban LBW and IM rates to target rates for Healthy People 2000 and 2010 objectives. Although the 2000 LBW weight rate for the 100 largest cities was higher than the average for the suburbs (8.

Public hospitals and substance abuse services for pregnant women and mothers: implications for managed-care programs and Medicaid.

Although an increasing proportion of the US population receives health services through managed care, pregnant women and mothers eligible for Medicaid who are involved with alcohol or other drugs are often excluded from these programs due in large part to lack of information on costs, service needs, and service use. To develop such information policy, service settings, and managed-care plans, the project conducted a national survey using a provider group with experience in caring for this population, the member universe of the National Association of Public Hospitals and Health Systems. The survey requested detailed information on hospital system information, current managed-care arrangements, outcome measurements, financing, service priorities, and service availability.

Community, service, and policy strategies to improve health care access in the changing urban environment.

Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities.

Access to care is the centerpiece in the elimination of socioeconomic disparities in health.

Many health care professionals have sustained an almost single-minded conviction that disparities in access to health care across socioeconomic groups are the key reason for the major discrepancies in health status between wealthy persons and poor persons. Others, however, have argued that a host of factors work to create major impediments and that reducing or eliminating financial barriers to health care in particular will do little to reduce discrepancies in health status. This paper, while acknowledging the spectrum of contributing factors, argues that the elimination of financially based differences in access is central to any effort to create equity in outcomes across socioeconomic groups.

A tale of two New Jersey cities.

Judging from the social and health measures considered in this article, Newark and Jersey City face similar challenges as other large cities. For Newark, the challenges are more extreme. The high rates of poverty and violence, coupled with a low rate of high school graduation and a large number of single parent households bode ill for the city.

U.S. hospital care for HIV-infected persons and the role of public, private, and Veterans Administration hospitals.

Hospitals are a major provider of medical care for human immunodeficiency virus (HIV)-infected persons. Although utilization and patterns of care profiles in public and private hospitals have been evaluated for acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), one of the most costly and common severe complications of AIDS, information from Veterans Administration (VA) hospitals has not been reported previously. This article reports on inpatient care for PCP patients by obtaining data from VA, private, and public hospitals.

The social and health characteristics of California cities.

This DataWatch presents information from nationally recognized sources on sociodemographic characteristics, crime, and hospitals for the sixteen largest cities in California. Recognizing that effective health system changes will require attention to these critical issues, the report identifies their status in a single year and documents changes since 1980. It also provides comparisons among these cities and for the 100 largest U.

U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals: 1988-1991.

Hospitals are a major provider of resources for individuals with HIV-related conditions. With the changing nature of HIV, tracking the dependence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents HIV inpatient care in U.

Comparisons of hospital care for patients with AIDS and other HIV-related conditions.

Objective: To compare utilization and financing of inpatient care for persons with the acquired immunodeficiency syndrome (AIDS) (as defined by the Centers for Disease Control) and those with "other HIV [human immunodeficiency virus]-related illness."

Design: A mailed survey of the members of five national organizations representing public, teaching, children's, community, and Catholic hospitals. The survey requested information on demographics, service utilization, costs, and financing of care for AIDS and other HIV patients.

Physician staffing in the emergency departments of public teaching hospitals: a national survey.

Study Hypothesis: To evaluate factors influencing emergency physician staffing patterns in an important subset of US hospitals.

Design: Survey of emergency department directors and hospital administrators.

Participants: Member institutions of the National Association of Public Hospitals and the Council of Teaching Hospitals.

Emergency departments and crowding in United States teaching hospitals.

Study Objectives: To assess the extent and distribution of hospital and emergency department crowding nationally.

Design: The research design consisted of a mailed questionnaire disseminated in the fall of 1988 to the member institutions of the National Association of Public Hospitals (NAPH) and the Council of Teaching Hospitals (COTH).

Type Of Participants: Study participants included hospital administrators and ED directors from 239 of the non-Veterans Administration, general acute care, US members of COTH and NAPH.