Reducing health disparities of culturally-diverse minority populations through transcultural nursing in the home

Author(s):

Woerner, L.; Duheme, M.; Zielinski, L.; Turchetti, S.

Format:

Book section

Publisher:

Nova Science Publishers, Inc., 2013.

Language:

English

Abstract:

The United States is increasingly becoming more diverse as minority populations grow and make up a larger percentage of our Nation each year. New York State is more diverse than most states. Some projections estimate that minorities will account for half of the Nation's population by 2050. A significant and growing percentage of these minority groups are 65 and older. This has serious implications for the health care system, as health disparities make elderly minorities more costly to the health care system than their majority counterparts, who already consume the most significant portion of the health care dollar. The concern about the ability of the health care system to accommodate disparate beliefs and health practices is addressed extensively in the health care literature. It is even addressed in popular literature, with a notable example being Anne Fadiman's award winning book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors and the Collision of Two Cultures. Now, as we focus on reforming health care, it is certainly the time to come together around solutions that have proven effective in reducing disparities like Transcultural home care. Home health care, through Certified Home Health Agencies (CHHA), is becoming increasingly important in the care of the elderly population as a whole, as chronic disease management becomes the focus for the elderly. This is especially true for the the diverse minority populations. Home care is much less costly than care provided in the inpatient setting, is the best locus of care, and adds the most value to the patient care experience. Therefore, home care offers a key opportunity to reduce some health disparities. Research shows that prevalence and management of chronic disease, medication adherence and errors, and avoidable hospitalizations are three major areas of health disparities among minority populations. These disparities could be reduced through the delivery of a Transcultural model of care in the home setting. Research on cultural competence and theory of Transcultural care lay the foundation for this model of care. HCR Home Care (HCR), a CHHA based in Rochester, New York, confirmed that Transcultural care can reduce disparities in minority populations. In a two-year pilot, Project ¡Éxito!, based on Leininger's Theory of Culture Care Diversity and Universality, HCR reduced acute hospitalizations and emergency care visits for Hispanic patients. Medication management and customer/nursing satisfaction were also improved. Rehospitalizations were reduced from 43 to 24 percent. There are several existing and emerging barriers to putting Transcultural care into home care practice throughout the U. S., including cuts to home care reimbursement, utilization management initiatives managing the process of delivering evidence-based care, and insurance rules that force patients into a lower level of care after an episode of skilled care. Continuing cuts to home care reimbursement through health care reform initiatives not only threatens the financial solvency of home care agencies, but also make it less likely that they will invest precious dollars in Transcultural training, processes, and programs. Utilization management initiatives based on standards of care, such as McKesson's Interqual Criteria, threaten the fundamentals of Transultural care by adopting a process to achieve evidence-based care processes, rather than simply focusing on outcomes to allow the care process to incorporate cultural differences. Insurance rules that force patients into a lower level of care, such as New York State's Personal Care Services Program, reduce patient access to Transcultural care because it removes the nursing component of care, after an episode of care, without recognizing that chronic disease is not an episode. © 2013 by Nova Science Publishers, Inc. All rights reserved.

ISBN:

9781626185708 (ISBN)

Identifier:

HmongStudies3667