www.mobilehealthmap.org 617‐442‐3200 New research shows that mobile health clinics improve health outcomes for hard to reach populations in cost‐effective and culturally competent ways . A Harvard Medical School study determined that for every dollar invested in a mobile health clinic, the US healthcare system saves $30 on average. Mobile health clinics, which offer a range of services from preventive screenings to asthma treatment, leverage their mobility to treat people in the convenience of their own communities. For example, a mobile health clinic in Baltimore, MD, has documented savings of $3,500 per child seen due to reduced asthma‐related hospitalizations. The estimated 2,000 mobile health clinics across the country are providing similarly cost‐effective access to healthcare for a wide range of populations. Many successful mobile health clinics cite their ability to foster trusting relationships. Qualitative research in such mobile health clinics has found that patients value the informal, familiar environment in a convenient location, with staff who “are easy to talk to,” and that the staff’s “marriage of professional and personal discourses” provides patients the space to disclose information themselves. A communications academic argued that mobile health clinics’ unique use of space is important in facilitating these relationships. Mobile health clinics park in the heart of the community in familiar spaces, like shopping centers or bus stations, which lend themselves to the local community atmosphere.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care

Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition.Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals’ implicit attitudes about racial/ethnic groups and health care outcomes.Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique.Selection Criteria. We assessed eligibility using double independent screening ba...

Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

Although the medical profession strives for equal treatment of all patients, disparities in health care are prevalent Cultural stereotypes may not be consciously endorsed, but their mere existence influences how information about an individual is processed and leads to unintended biases in decision-making, so called “implicit bias” All of society is susceptible to these biases, including physicians Research suggests that implicit bias may contribute to health care disparities by shaping physician behavior and producing differences in medical treatment along the lines of race, ethnicity, gender or other characteristics We review the origins of implicit bias, cite research documenting the existence of implicit bias among physicians, and describe studies that demonstrate implicit bias in clinical decision-making We then present the bias-reducing strategies of consciously taking patients’ perspectives and intentionally focusing on individual patients’ information apart from their social group We conclude that the contribution of implicit bias to health care disparities could decrease if all physicians acknowledged their susceptibility to it, and deliberately practiced perspective-taking and individuation when providing patient care We further conclude that increasing the number of African American/Black physicians could reduce the impact of implicit bias on health care disparities because they exhibit significantly less implicit race bias

Physicians and Implicit Bias: How Doctors May Unwittingly Perpetuate Health Care Disparities

A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test

Objectives. We conducted a review to examine current literature on the effects of interpersonal and institutional racism and discrimination occurring within health care settings on the health care received by racial/ethnic minority patients.Methods. We searched the PsychNet, PubMed, and Scopus databases for articles on US populations published between January 1, 2008 and November 1, 2011. We used various combinations of the following search terms: discrimination, perceived discrimination, race, ethnicity, racism, institutional racism, stereotype, prejudice or bias, and health or health care. Fifty-eight articles were reviewed.Results. Patient perception of discriminatory treatment and implicit provider biases were the most frequently examined topics in health care settings. Few studies examined the overall prevalence of racial/ethnic discrimination and none examined temporal trends. In general, measures used were insufficient for examining the impact of interpersonal discrimination or institutional racism...

The State of Research on Racial/Ethnic Discrimination in The Receipt of Health Care

The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispanic Whites. The IAT results indicate that these health care preprofessionals exhibit implicit race and skin tone biases: preferences for Whites versus Blacks and light skin versus dark skin. Cultural competency curricula and disparities research will be advanced by understanding the factors contributing to cultural competence and bias.

Cultural competency, race, and skin tone bias among pharmacy, nursing, and medical students: implications for addressing health disparities.

Family caregivers represent a key informal support mechanism, with cost estimates of their value varying by the type of person cared for, disease state, or whether care is national or local. This study provides national estimates of the economic value of family caregiving based on national time and motion survey time diary entries. All components of the cost estimate (i.e., time, wages, and prevalence) are derived from the same data source. In 2009, we estimate an annual economic value of over $$335 billion for unpaid national caregiving services using a replacement wage for the value of caregiver time. Further an annual economic value of $641 billion for unpaid national caregiving is estimated when an opportunity wage value of caregiving time is used. The paper concludes with a discussion of policy implications of our findings.

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Zhiyong Dong

Papers

Cultural competency, race, and skin tone bias among pharmacy, nursing, and medical students: implications for addressing health disparities.

Valuing the Costs of Family Caregiving: Time and Motion Survey Estimates