Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar.

Purpose Of Review: To summarize evidence of impact of social determinants of health (SDOH) on diabetes risk, morbidity, and mortality and to illustrate this impact in a population context.

Recent Findings: Key findings from the American Diabetes Association's scientific review of five SDOH domains (socioeconomic status, neighborhood and physical environment, food environment, health care, social context) are highlighted. Population-based data on Black/African American adults illustrate persisting diabetes disparities and inequities in the SDOH conditions in which this population is born, grows, lives, and ages, with historical contributors.

Reducing readmissions using teach-back: enhancing patient and family education.

This article describes a quality improvement initiative, implemented by a patient education workgroup within a tertiary Magnet® facility. The project focused on the association between inadequate care transitions in patients with heart failure and subsequent costly readmissions. The teach-back initiative was piloted with patients hospitalized with heart failure, because of this population's high risk of readmission.

Physician clinical alignment and integration: a community-academic hospital approach.

An overwhelming need for change in the U.S. healthcare delivery system, coupled with the need to improve clinical and financial outcomes, has prompted hospitals to direct renewed efforts toward achieving high quality and cost-effectiveness.

Prioritizing partners across the continuum.

With the advent of accountable care organizations, bundled payments, value-based purchasing, and penalties for preventable hospital readmission, tight connections and collaboration across the care continuum will become critical to achieve successful patient outcomes and to reduce the cost of care delivery. Lehigh Valley Health Network (LVHN), the largest provider of health services in eastern Pennsylvania, set out on a journey to build collaborative relationships with skilled nursing facilities (SNFs) in their eastern Pennsylvania community. LVHN desired SNF partners with mutual interests in improving quality of care and lowering costs of delivery where possible.

Getting published in an academic-community hospital: the success of writing groups.

Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the professional literature.

Defining and targeting health care access barriers.

The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive.

Developing a culturally competent health network: a planning framework and guide.

The number of cultural competency initiatives in healthcare is increasing due to many factors, including changing demographics, quality improvement and regulatory requirements, equitable care missions, and accreditation standards. To facilitate organization-wide transformation, a hospital or healthcare system must establish strategic goals, objectives, and implementation tasks for culturally competent provision of care. This article reports the largely successful results of a cultural competency program instituted at a large system in eastern Pennsylvania.

Understanding the role of the promotora in a Latino diabetes education program.

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community.

Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

Context/objectives: We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs.

Methods: Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services.

Results: Sixty-seven hospitals responded (55% response rate).

Barriers and facilitators for colorectal cancer screening practices in the Latino community: perspectives from community leaders.

Background: Colorectal cancer (CRC) is the second-leading cause of cancer-related death in the United States and the third most commonly diagnosed cancer among Latinos. While Latinos represent one of the fastest-growing ethnic groups in the United States, their participation in cancer prevention and treatment trials is low.

Methods: Thirty-six Latino community leaders participated in five focus groups that examined factors affecting CRC screening practices among Latinos.

Perspectives on cancer screening among Latino community members and internal medicine residents.

Background: Latinos have lower rates of cancer screening, partially because of cultural beliefs that conflict with those of health care professionals. Moreover, established programs for training physicians in cultural competency often fail to incorporate input from the community.

Methods: To explore beliefs about cancer and cancer screening among Latino community members and internal medicine residents.

Antecedents to effective treatment of hypertension in Hispanic populations.

Hypertension is a common medical disorder affecting >50 million people. It is a primary modifiable risk factor to cardiovascular disease and a leading cause of death in black and Hispanic groups. This article focuses on patient-specific and physician-specific barriers that contribute to underdiagnosis, undertreatment, access issues, and poor adherence to therapy.

Cultural competency as it intersects with racial/ethnic, linguistic, and class disparities in managed healthcare organizations.

Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings.

Latinas and HIV/AIDS risk factors: implications for harm reduction strategies.

Objectives: We examined risk factors for HIV infection among Puerto Rican and Mexican American women aged 15 through 44 years.

Methods: We used data from the 1995 National Survey of Family Growth. Analyses focused on the relation between sex role attitudes, sex education, anxiety, and consistent condom use.

Influenza vaccination among minority populations in the United States.

Background: A large portion of the elderly population of the United States fails to receive an annual influenza vaccination. Minorities may receive disproportionately fewer vaccinations. The objectives of this study were to (a) estimate the levels of influenza vaccination among noninstitutionalized, U.