Williams and Rucker 2000 argue, based largely on studies outside of health care, that negative stereotypes about minorities are an important explanation for health care disparities. The advantages of interdisciplinary teams are clear: management of complex cases requires input from multiple disciplines who feel free to speak up, disagree, and advocate in a way that unidisciplinary and even multidisciplinary teams tend to stifle. Am J Kidnev Dis 1997:29:720-8. Not surprisingly, the federal government has attempted to shape hiring and care policies through these subsidies. Legal, Regulatory, and Policy Interventions Avoid fragmentation of health plans along socioeconomic lines Recommendation 5-1.
Students and new clinicians may be so focused on mastering specific clinical skills that they have little time to observe or question the whole process of care. Side rails can be climbed over, under, or through. The disproportionate presence of racial and ethnic minorities in lower-end health plans is a potential source of healthcare disparities, given that ef- forts to control for insurance status in studies of healthcare disparities have not taken detailed account of variations among health plans. Environmental Scan: Latino Access to Primary and Preventive Care. Tools has since lost his battle for life, but will be remembered as a hero for undergoing an experimental technology and paving the way for other patients to undergo the procedure.
The database must be large enough and fast enough to deal with the number of patients and users for the institution. New types of data, such as whether a patient has a specific genetic risk factor, will be seen in the medical record of the future. The effort to reduce the average length of stay in the hospital spurred an escalating demand for lower-intensity care settings that could monitor the convalescent phase of recovery from the acute episode that had precipitated the hospitalization. Managing risks in managed care. Raymond and Karen Goldsteen, to add their expertise in public health and health policy and management to this outstanding volume.
Some plans offer limited services only at their facilities, using salaried providers. Despite initial resistance, hospitals and doctors, particularly in markets with an excess supply of beds and physicians, often offered discounts to insurance plans in order to beat their competitors to the promised volume of referrals. Our analysis will be conducted using two racial groups, but it applies to ethnic as well as racially defined minorities. Health systems should base decisions about resource allocation on published clinical guidelines, insure that physician financial incentives do not disproportionately burden or restrict minority patients' access to care, and take other steps to improve access - including the provision of interpretation services, where community need exists. Annals of Internal Medicine, 135 5 :352-366.
Excerpts from the United States Renal Data System 1999 annual data report. Medical institutions will require information systems that comply with these standards or face legal consequences. It was not until 1965 that Lyndon B. New England Journal of Medicine, 340, 327-332. Given need or severity, Blacks and Whites are treated the same. American College of Nurse Practitioners. A wage index that reflects the cost of hospital wages in a metropolitan or a statewide rural area is applied to the standard case rate to adjust for local labor costs.
This is usually accomplished by an amendment to the hospital's staff bylaws and should include a clear delineation of privileges and lines of responsibility. However, diploma graduates who attend college often are not able to transfer the credits earned in the diploma program because until recently most of these programs were not degree-granting institutions. Moreover, the fact that Tools was African American and his doctors were white seemed, for most Americans, to symbolize the irrelevance of race in 2001. Medicaid also followed suit by establishing mandatory enrollment into managed care plans for some beneficiaries. The executive summary of Unequal Treatment is included in this briefing packet. Another opportunity for education in nursing is the external degree program, such as that offered by the Board of Regents of New York State. Racial differences in the use of invasive cardiovascular procedures: Review of the literature and prescription for future research.
As a result, length of stay declined between 1970 and 1998 from 13. The team is recommending nursing home placement. They will continue to provide the most sophisticated, highly intensive care and will therefore remain as the most costly care setting. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. Different numbers of Blacks and Whites may get treatment, but this does not constitute a disparity. Traditionally, medical knowledge has been captured in textbooks, in research literature, and in the minds of experts. Strengthen the stability of patient-provider relationships in publicly funded health plans Rec- ommendation 5-2.
Extremely costly cases can qualify for an additional outlier case amount. Many hospitals diversified into home care, rehabilitative care, and long-term care for patients in the convalescent phases of their illnesses Burda, 1993. Because of the high rate of infection, a catheter should never be placed routinely on admission, and it should be removed as soon as possible. Raik Your college roommate calls from out of state to ask you to look in on his previously independent grandmother, who has been a patient in your hospital for the last 4 days. As the technological advances of the twentieth century turned hospitals into complex institutions of care, payment sources for health care also expanded in scope and complexity. A rule-based policy is never fair except in the case of a policy strictly dominated in efficiency terms.
Report to the Congress: Medicare payment policy. Consider the implications of a rule-based policy in the stereotyping model analyzed in Section 5. As such, each state has its own legal definition of the practice of nursing. He completed an internal medicine residency at Henry Ford Hospital and a Master's in Health Services Administration at the University of Michigan School of Public Health in Ann Arbor. All students of health care administration and policy, as well as practicing healthcare professionals who simply want a relatively brief overview of the system, will find it useful.
Although residency is clearly educational, learning takes place in a different context, includes different content, and occurs via processes that are often implicit: In early October, after three months of internship, Dr. This is another example of how we must resist the instincts—in this case, to give a prn sleeping pill. Journal of the American Medical Association, 286, 1023-1024. By examining the myths in some detail we can see how to fight our own instincts, and instead provide the best care for our patients. One of the consequences of these changes is the mix of intentional and unintentional incentives generated from payment policies specific to institutions and individual providers.