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Document Type:Latin Dissertation
Language of Document:English
Record Number:53433
Doc. No:TL23387
Call number:‭3235893‬
Main Entry:Laurie Nsiah-Jefferson
Title & Author:Evidence-based quality enhancement and treatment inequities. The influence of overall institutional success and other hospital characteristics on adherence to ACC/AHA guidelines for NSTE-ACS by race and gender: A critical race theory perspectiveLaurie Nsiah-Jefferson
College:Brandeis University, The Heller School for Social Policy and Management
Date:2006
Degree:Ph.D.
student score:2006
Page No:228-228 p.
Abstract:Despite racial/ethnic and gender inequities in cardiovascular care for U.S. adults, there is no consensus on strategies to equalize care. Policy and institutional leaders have advocated implementation of evidence-based guidelines as the solution to care inequities. It is unclear if this approach reduces inequities. Theories of organizational problem solving, critical race and critical race feminist theories, and other research suggest that hospital organizational factors influence inequities in care. This study examines the influence of evidence-based guidelines and hospital structures, contexts and resources on race and gender inequities in NSTE-ACS treatment, utilizing cross-sectional retrospective data from Duke Medical Center's CRUSADE Project and the American Hospital Association's Annual Survey. Subjects are 80,232 patients diagnosed with NSTE-ACS, hospitalized in 282 hospitals from January 2003 to December 2004. Multilevel modeling is used to test how race, gender, and hospital factors are associated with adherence to NSTE-ACS guidelines. Findings show that health care quality is poor for the overall population; inequities persist for women and African-Americans despite QI efforts; overall hospital adherence does not predict adherence for African-Americans; hospital structure, context and resources have varying impacts depending on the race/gender group. Results can assist QI professionals to identify patient and hospital characteristics that facilitate or impede the delivery of guideline concordant care. It can also help better tailor QI programs to address the needs of female and African-American patients.
Subject:Health and environmental sciences; Social sciences; Treatment inequities; Institutional success; Hospital; Race; Gender; Quality of care; Public health; Minority & ethnic groups; Sociology; Health care; Hospitals; Patient care planning; Racial differences; Gender differences; Models; African Americans; Women; Evidence-based medicine; 0769:Health care; 0573:Public health; 0631:Sociology; 0631:Minority & ethnic groups
Added Entry:J. Capitman
Added Entry:Brandeis University, The Heller School for Social Policy and Management