In the United States, the Institute of Medicine (IOM) Report Crossing the Quality Chasm, released in 2001, highlights that there is a significant gap between the quality of health care people should receive, and the quality of health care people do receive. Just a year later, another influential IOM Report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, was released highlighting an even larger quality chasm for racial/ethnic minorities in the United States. The root causes for these disparities, which were identified for racial and ethnic minorities with the same insurance and socioeconomic status at their white counterparts, were determined to be due to:
- Health System Factors: These include issues related to the complexity of the health care system, the difficulty that minority patients may have in navigating this complex health system
- Provider-Level Factors: These include issues related to health care providers, and the challenges they face caring for patients with limited-English proficiency,
- Patient-Level Factors: These include patients who may refuse certain services, or have poor adherence to treatment due to cultural barriers or lack of understanding.
As a strategy for addressing these barriers, three models for organizing health promoting and integrated and continuous healthcare for minorities, using lay health workers, have emerged. These programs focus on the use of:
- Health Coaches: Individuals based at the health care site that continuously assist patients with chronic disease management (such as diabetes)
- Healthcare Navigators: Individuals that are based at the health care site who help patients navigate the health care system, particularly assuring they get preventative screening tests (such as colonoscopies) if they haven’t gotten them, or that they aren’t lost to follow-up when they’ve had an abnormal test (i.e. mammogram or pap smear)
- Community Health Workers: Individuals that are based in the community and visit the patient’s home to assist them with chronic disease management (such as asthma)
This presentation will highlight some of the key challenges minority patients face in their attempts to benefit from health promotion interventions and disease management, as well as provide an overview of several strategies being used to address them, with a focus on the use of health coaches, navigators, and community health workers. It will also share some lessons learned from these programs, as well as some basic recommendations.