Culturally Effective Pediatric Care: Recommendations for

Education and Health Policy

Ethan Alexander Jewett, MA

November 20, 2006

Why culturally effective care?

A variety of terms: what’s the difference?cultural competencycultural sensitivityculturally effective care

Culturally effective care focuses on the outcome of the interaction between the health care provider and the patient.

An expanded definition

RaceEthnicity

RaceEthnicityLanguageReligionSexual orientationGenderDisabilitySocioeconomic status

1999 2004

Pros/Cons of Expanded Definition

Acknowledges that other attributes effect the delivery and quality of care beyond race and ethnicity

Recognizes that other cultural groups have health disparities

In line with policy of other organizations

Dilutes focus on race and ethnicity, on which little progress has been made to date

More groups sharing limited funds for diversity programs

Makes data collection on diversity difficult

Pros Cons

Recommendation 1

Develop curriculaImpact of provider’s cultural

norms on delivery of careEducation tailored for each

stage of educational spectrumCurricula should include full

range of cultural attributes

Recommendation 2Institutional commitment

necessaryDevelop policies and plans to

identify community needs and support community programs.

Disparities between cultural attributes and health status of providers and those of patients being served.

Recommendation 3No unfunded government

mandatesBurden should not fall

disproportionately on payers and providers

Inadequate reimbursementFinancial viability of health

systems threatened.

Recommendation 4

Establish federal and state incentive programs on culturally effective care

Must be an evaluative component to measure access and outcomes

Reward physicians for improving careEstablish incentive programs to encourage

physician practice to the underserved

Recommendation 5

Medical students and residents should learn a second language

Reward medical students and residents for preparing themselves to care for underserved patients.

Recommendation 6

Pediatricians should be leaders in advocating for culturally effective care

Identify best interest of pediatric patients

Promote public policy in support of children

How do we get from theory to practice?

Most resources are conceptual: the feel-good “we need to do the right thing” approach.

Few resources on culturally effective care focus on the nuts-and-bolts of implementation.

There are educational issues, and then there are systems issues.

How do evaluate the success of interventions, and how do measure our improvement?

Possible Next Steps for COPEIdentify existing culturally effective care resources

for residents and practicing pediatricians. Each has different needs.

Work with other organizations: NHMA, NMA, GLMA, AMA-RFS, APPD, etc.

Produce a resource guide for residents.Push for advocacy training that focuses on CEPCDevelop an e-learning module for

residents/pediatricians on CEPC.