On the 50th anniversary of the passage of America's Voting Rights Act and the historic
civil rights march from Selma to Montgomery, with the country confronting an ever-increasing
diversification of its population, we are still grappling with structural racialization
and its inextricable link to poverty. Economic inequality is the highest it has been
since 1928. Disparity, with its fractal-like presence, permeates far too many facets
of our society including employment opportunity, law enforcement, criminal justice,
education, housing, voting rights, and financial lending. Our health care system is
an integral part of this troubling phenomenon with systems, structures, and processes
of care that reinforce disparity, the root causes of which are complex, troubling,
and without simple solutions.
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Keywords
List of abbreviations:
CQI (continuous quality improvement), NHB (non-Hispanic black), NHW (non-Hispanic white), SCI (spinal cord injury), TBI (traumatic brain injury)To read this article in full you will need to make a payment
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References
- Unequal treatment: confronting racial and ethnic disparities in health care [executive summary].National Academies Pr, Washington (DC)2003
- Crossing the quality chasm: a new health system for the 21st century.National Academies Pr, Washington (DC)2001
National Cancer Institute. Cancer health disparities definitions; 2015. Available at: http://crchd.cancer.gov/. Accessed February 22, 2015.
- Unequal treatment: confronting racial and ethnic disparities in health care.National Academies Pr, Washington (DC)2002
- In the nation’s compelling interest: ensuring diversity in the health care workforce.National Academies Pr, Washington (DC)2004
U.S. Department of Health and Human Services. Strategic plan for 2010-2015. 2015. Available at: http://www.hhs.gov/secretary/about/priorities/priorities.html. Accessed April 12, 2015.
Department of Health and Human Services. HHS 2011 action plan to reduce racial and ethnic health disparities. 2015. Available at: http://minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete. Accessed April 12, 2015.
AHRQ. 2014 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Pub No 15-0007.
AHRQ. 2013 National Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; 2014. AHRQ Pub No 14-0006.
- The intersection of disability and healthcare disparities: a conceptual framework.Disabil Rehabil. 2015; 37: 632-641
- The association of race, cultural factors, and health-related quality of life in persons with spinal cord injury.Arch Phys Med Rehabil. 2011; 92: 441-448
- Vulnerable groups living with spinal cord injury.Top Spinal Cord Inj Rehabil. 2011; 17: 1-9
- Measuring individual differences in implicit cognition: the Implicit Association Test.J Pers Soc Psychol. 1998; 74: 1464-1480
- Understanding and using the Implicit Association Test: II. Method variables and construct validity.Pers Soc Psychol Bull. 2005; 31: 66-180
- State of the science: implicit bias review.Kirwan Institute, Columbus2013
- Disparities in postacute rehabilitation care for stroke: an analysis of the state inpatient databases.Arch Phys Med Rehabil. 2011; 92: 1220-1229
- Racial and ethnic differences in postacute rehabilitation outcomes after stroke in the United States.Stroke. 2008; 39: 1514-1519
- Disparities in vocational rehabilitation services and outcomes for Hispanic clients with traumatic brain injury: do they exist?.J Head Trauma Rehabil. 2007; 22: 85-94
- Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.J Neurosurg. 2015; 122: 595-601
- Race and insurance disparities in discharge to rehabilitation for patients with traumatic brain injury.J Neurotrauma. 2013; 30: 2057-2065
- Racial disparities in outcomes of persons with moderate to severe traumatic brain injury.Med Care. 2007; 45: 686-690
- Disparities in utilization of outpatient rehabilitative care following hip fracture hospitalization with respect to race and ethnicity.Arch Phys Med Rehabil. 2009; 90: 560-563
- Racial disparities in outcomes after spinal cord injury.J Neurotrauma. 2013; 30: 492-497
- Ethnic disparities exist in trauma care.Trauma. 2007; 63: 1138-1142
- Inequity of rehabilitation services after traumatic injury.J Trauma. 2009; 66: 255-259
- Postacute rehabilitation care for hip fracture: who gets the most care?.J Am Geriatr Soc. 2012; 60: 1929-1935
- Health care utilization and needs after pediatric traumatic brain injury.Pediatrics. 2006; 117: 663-668
- Socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1159-1164
- Impact of state Medicaid coverage on utilization of inpatient rehabilitation facilities among patients with stroke.Stroke. 2014; 45: 2472-2474
- Disparities in outpatient and home health service utilization following stroke: results of a 9-year cohort study in northern California.PM R. 2009; 1: 997-1003
- Disparities in stroke rehabilitation: results of a study in an integrated health system in northern California.PM R. 2009; 1: 29-40
- Disparities in postacute stroke rehabilitation disposition to acute inpatient rehabilitation vs. home: findings from the North Carolina Hospital Discharge Database.Am J Phys Med Rehabil. 2009; 88: 100-107
- Variation in pediatric traumatic brain injury outcomes in the United States.Arch Phys Med Rehabil. 2014; 95: 1148-1155
- Gender and ethnic differences in rehabilitation outcomes after hip-replacement surgery.Am J Phys Med Rehabil. 2008; 87: 567-572
- Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injury.Arch Phys Med Rehabil. 2014; 95: 2140-2151
- Race/ethnicity and outcomes following inpatient rehabilitation for hip fracture.J Gerontol A Biol Sci Med Sci. 2008; 63: 860-866
- Black-white disparities in motor function outcomes taking into account patient characteristics, nontherapy ancillaries, therapy activities, and therapy interventions.Arch Phys Med Rehabil. 2010; 91: 1722-1730
- Racial disparities in stroke functional outcomes upon discharge from inpatient rehabilitation facilities.Disabil Rehabil. 2010; 32: 1604-1611
- Examining implicit bias of physicians who care for individuals with spinal cord injury: a pilot study and future directions.J Spinal Cord Med. 2015; 38: 102-110
- Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients.J Gen Intern Med. 2007; 22: 1231-1238
- Physicians’ implicit and explicit attitudes about race by MD race, ethnicity, and gender.J Health Care Poor Underserved. 2009; 20: 896-913
- Physician implicit attitudes and stereotypes about race and quality of medical care.Med Care. 2008; 46: 678-685
- The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care.Am J Public Health. 2012; 102: 979-987
- Assessment of biases against Latinos and African Americans among primary care providers and community members.Am J Public Health. 2013; 103: 92-98
- Depression after spinal cord injury: relation to gender, ethnicity, aging, and socioeconomic indicators.Arch Phys Med Rehabil. 2000; 81: 1099-1109
- Risk of hospitalizations after spinal cord injury: relationship with biographical, injury, educational, and behavioral factors.Spinal Cord. 2009; 47: 692-697
- Disparities in subjective wellbeing, participation, and health after spinal cord injury: a 6-year longitudinal study.NeuroRehabilitation. 2009; 24: 47-56
- Aversive racism and medical interactions with black patients: a field study.J Exp Soc Psychol. 2010; 46: 436-440
- The influence of implicit bias on treatment recommendations for 4 common pediatric conditions: pain, urinary tract infection, attention deficit hyperactivity disorder, and asthma.Am J Public Health. 2012; 102: 988-995
- On the nature of prejudice: automatic and controlled processes.J Exp Soc Psychol. 1997; 33: 10-40
- Understanding and using the Implicit Association Test: III. Metaanalysis of predictive validity.J Pers Soc Psychol. 2009; 97: 17-41
- Relations among the Implicit Association Test, discriminatory behavior, and explicit measures of racial attitudes.J Exp Soc Psychol. 2001; 37: 435-442
- Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions.BMC Public Health. 2006; 6: 104
- Recommendations for teaching about racial and ethnic disparities in health and health care.Ann Intern Med. 2007; 147: 654-665
- Leveraging quality improvement to achieve equity in health care.Jt Comm J Qual Patient Saf. 2010; 36: 435-442
- Quality and equity of care in U.S. hospitals.N Engl J Med. 2014; 371: 2298-2308
- Ulmer C. McFadden B. Nerenz D.R. Race, ethnicity, and language data: standardization for health care quality improvement. National Academies Pr, Washington (DC)2009
- Methodological issues in the collection, analysis, and reporting of granular data in Asian American populations: historical challenges and potential solutions.J Health Care Poor Underserved. 2010; 21: 1354-1381
Article info
Publication history
Published online: May 06, 2015
Footnotes
Supported in part by the National Institute of Child Health and Human Development (grant no. 1K23HD078453-01) and by the Centers for Disease Control and Prevention (grant no. 5 UO1 CE0002196-03).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
