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Expert urges better data on who lacks medical care

Numerous studies have erased any doubt about one of medicine's biggest flaws -- that racial and ethnic minorities tend to receive poorer quality health care than whites.

What is needed now, Dr. Bruce Siegel says, is a committed effort to do something about it.

Step One should start with good data that zeroes in on who is not receiving good care, said Siegel, a national expert who spoke Thursday in Buffalo at the annual conference of the P2 Collaborative of Western New York, a coalition of health-related groups involved in regional quality programs.

"There are dangerous gaps between the health care patients receive and the care they should receive," said Siegel, director of the Robert Wood Johnson Foundation's Aligning Forces for Quality initiative.

Poor Americans and racial and ethnic minorities suffer from higher rates of disease and experience reduced access to care. Such gaps vary by location across the country and disproportionately affect Hispanics and African-Americans, regardless of their wealth, Siegel said.

What makes the problem even more daunting is that the U.S. Census Bureau estimates that minorities will comprise a majority of the nation's population sometime after 2040.

"We are in the midst of becoming a very different country. The care we provide to Latinos and blacks will define the care we provide to most people," he said.

To address the gaps in care, hospitals, physicians and health insurers should start by collecting standardized data on patients' race, ethnicity and primary language, according to Siegel.

His view is backed by a recent recommendation by the Institute of Medicine, which advises the federal government on medical issues.

"Hospital leaders want to believe that their hospitals provide equal care regardless of a patient's race, ethnicity or primary language, but few know for sure. Without uniform standards for collecting this information, there is no way of knowing if all patients receive the same level of care," the report concluded.

Siegel offered the example of a Mississippi medical center that sought to improve its heart care to minorities. In a more detailed study of its patients, the hospital learned that it was caring for far more Spanish-speaking patients than expected.

"They shed light on a part of their community they didn't even know existed," he said.

The finding resulted in the hospital bringing in three Spanish-speaking translators.

Three Buffalo hospitals -- Erie County Medical Center, Buffalo General and Millard Fillmore -- have been selected by the Robert Wood Johnson Foundation to participate in an initiative to improve treatment of heart attack and heart failure that will emphasize the collection of data on patients' race, ethnicity and language.

Siegel said the level of collaboration among the three big facilities here is unmatched in the nation.


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