QUALITY AND CULTURE

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BACKGROUND

Clearly, the lack of access to health care and concomitant disparities in health status of forty four million uninsured Americans is outrageous and unacceptable. For thirty years the Bureau of Primary Health Care (BPHC), through its funded programs, has emerged as a national leader in providing primary health care to underserved and uninsured populations (low income, ethnic and racial communities, people with limited English proficiency and low health literacy, immigrants, refugees, migrant farm workers, rural residents, people experiencing homelessness, people with disabilities, and sexual minorities). BPHC exists to provide culturally and linguistically appropriate, high quality, comprehensive, coordinated primary and preventive care developed and implemented at the community level with empowered consumers driving the system. In order for this vision to be realized, service networks have to be strengthened and expanded through the development of national and community partnerships.

BPHC's mission to increase access to comprehensive health care and to improve the health status of underserved and vulnerable populations and its campaign to achieve 100% access and zero health disparities are clearly set forth in its strategic plans.

PROGRESS

Over the years there has been considerable progress at BPHC in integrating Cultural Competence Bureau-wide:

• Four new collaborative volumes of the nine-book Cultural Competence Monograph Series have been published with one volume on American Indians and Alaska Natives released in Fall, 2000. Order Publications

• A Hispanic Cultural Competence Primer was released in Fall 2000. Order Publications

• Cultural Competence: A Journey was published October 1999. http://bphc.hrsa.gov/culturalcompetence/

• Dissemination of English & Spanish Substance Abuse Clinical Desk Reference to all Bureau-funded programs (collaboration with SAMHSA). Order Publications

• Policy Document Translation Project (BPHC Program Expectations documents for community boards in Spanish, Cantonese and Vietnamese will be released Fall 2000. Order Publications

• A Hispanic Substance Abuse Training Project (coordinated with SAMHSA, NIH and OMH) was conducted in 1999-2000.

NEW DIRECTIONS, NEW OPPORTUNITIES, NEW CENTURY

The Quality Center conducts projects that emphasize the link between quality and cultural diversity. Projects that are currently under development include:

Electronic Providers Guide on Quality and Cultural Diversity

Cultural diversity is a global healthcare issue. Agencies, around the world, both internationally and domestically have developed resources for culturally and linguistically appropriate health services. Through the Quality Center at the Bureau of Primary Health Care, HRSA is commencing development of a web-based guide to these resources. Following a quality review of existing global healthcare materials, BPHC will place these resources on the WWW, through the HRSA, BPHC and other web-sites. In conjunction with Management Sciences for Health, a not-for-profit global health care consulting organization with particular emphasis on developing countries, this interactive resource will be updated on an ongoing basis.  http://erc.msh.org/quality&culture

Interactive Media Training Program on Quality and Cultural Diversity

Through the Quality Center at the Bureau of Primary Health Care, HRSA is providing seed funding to the American Academy of Family Physicians (AAFP) to develop A Quality Care for a Diverse Population (QCDP) training and educational program for family practice physicians and other primary health care providers. Family physicians and other primary health care providers care for individuals from a diverse set of cultures, backgrounds, and socioeconomic groups. The biomedical model is traditionally taught in medical and health care education with a focus on diagnosis and curing disease. For family physicians and other primary health care providers to continue to deliver appropriate, high quality health care, they must understand the sociocultural factors influencing their patients. Furthermore, providers must realize how their own perceptions, beliefs, and biases influence the clinician-patient relationship. Ignoring cultural differences may result in a number of poor quality of care results including inappropriate health care utilization, non-adherence with treatment regimens, poor patient satisfaction and poor outcomes. Beyond those effects, negative economic consequences may result from being unprepared for the demographic changes taking place in the United States.

Culture, Ethnicity, and Health Disparities

Clearly, culturally and linguistically appropriate health services are essential ingredients in quality health care. Cultural and linguistic factors are crucial contributors to the development and delivery of quality care to all people. These factors are especially important in our pursuit of the total elimination of health disparities in ethnic and racial communities. According to the Kaiser family foundation:

"While many factors have been indicated as contributors to health disparities experienced by racial and ethnic groups in the United States, the lack of health insurance and other barriers to obtaining health services markedly diminish minorities' use of both preventive services and medical treatments. The Kaiser Commission on Medicaid and the Uninsured has released some helpful resources examining health insurance coverage and access to physician services among America's largest racial and ethnic minority groups. Racial and Ethnic Disparities in Access to Health Insurance and Health Care, a report by the UCLA Center for Health Policy Research and the Kaiser Family Foundation, is the first of its kind to include information on health insurance coverage and access for subgroup populations of Latinos (Central and South Americans, Cubans, Mexicans and Puerto Ricans) and Asian Americans/Pacific Islanders (Chinese, Filipino, Koreans, South East Asians, Japanese, and South Asians). The report is available online at www.kff.org/kcmu, or at www.healthpolicy.ucla.edu. Four new fact sheets on health insurance coverage and access for each of these minority population groups are also now available at www.kff.org/kcmu."

Open Power Point Presentation:  Cultural Competence:  An Essential Ingredient for Quality, Access & Elimination of disparities

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A new web resource to assist health care professionals in providing quality culturally and linguistically appropriate services to multicultural populations  http://erc.msh.org/quality&culture. The Provider's Guide was developed by Management Sciences for Health (MSH), a not-for profit global health organization.

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