Delivering Consistent and Equitable Healthcare

  • Gregory L. Hall


Being consistent and equitable in your care of African Americans is critical and has been key to decreasing a number of health disparities. Consistency (doing the same thing the same way each time) and equity (providing fair and impartial treatment) can at times be at odds because technically, they are not the same. What modern healthcare strives to do is be more consistent across populations, and this attempt at consistency frequently fails due to variability in access, insurance coverage, provider idiosyncrasies, and patient need. Chapter 3 reviews the numerous inferior outcomes in the clinical care of African American patients that are provider-driven, and therefore not based on socioeconomic status or lack of insurance. Health disparities exist because of a host of situations that most clinicians believe are ‘out of their control’ like poverty, access to insurance, or health literacy. This chapter shows specifically how providers contribute to poor outcomes in African Americans, and provides a rationale as to how it can be remedied.


  1. 1.
    2015 National Healthcare Quality and Disparities Report Chartbook on Health Care for Blacks. Rockville: Agency for Healthcare Research and Quality; 2016. AHRQ Pub. No 16-0015-1-EF.Google Scholar
  2. 2.
    Gomez MA, Anderson JL, Karagounis LA, Muhlestein JB, Mooers FB. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol. 1996;28:25–33.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Pope JH, Aufderheide TP, Ruthazer R, Woolard RH, Feldman JA, Beshansky JR, Griffith JL, Selker HP. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163–70.Google Scholar
  4. 4.
    Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008;16:191–6.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Grief SN, Loza JK. Guidelines for the evaluation and treatment of pneumonia. Prim Care. 2018;45(3):485–503. Scholar
  6. 6.
    Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754–832.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Rinella ES, Shao Y, Yackowski L, et al. Genetic variants associated with breast cancer risk for Ashkenazi Jewish women with strong family histories but no identifiable BRCA1/2 mutation. Hum Genet. 2013;132(5):523–36.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Jasperson KW, Tuohy TM, Neklason DW, Burt RW. Hereditary and familial colon cancer. Gastroenerology. 2010;138960:2044–58.Google Scholar
  9. 9.
    2017 National Healthcare Quality and Disparities Report. Retrieved from 2018. Accessed 8 May 2019.
  10. 10.
    Poverty rate by race/ethnicity. Henry J Kaiser Family Foundation. Accessed 9 May 2019.
  11. 11.
    Carvalho E, Bettger JP, Goode AP. Insurance coverage, costs, and barriers to care for outpatient musculoskeletal therapy and rehabilitation services. N C Med J. 2017;78(5):312–4.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Sandstrom R, Bruns A. Disparities in access to outpatient rehabilitation therapy for African Americans with arthritis. J Racial Ethn Health Disparities. 2016;4(4):599–606.Google Scholar
  13. 13.
    Betancourt JR. Eliminating racial and ethnic disparities in health care: what is the role of academic medicine? Acad Med. 2006;81(9):788–92.Google Scholar
  14. 14.
    Simpson DR, Martínez ME, Gupta S, Hattangadi-Gluth J, Mell LK, Heestand G, et al. Racial disparity in consultation, treatment, and the impact on survival in metastatic colorectal cancer. JNCI: J Natl Cancer Inst. 2013;105(23):1814–20.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Murphy MM, Simons JP, Ng SC, Mcdade TP, Smith JK, Shah SA, et al. Racial differences in cancer specialist consultation, treatment, and outcomes for locoregional pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16(11):2968–77. Scholar
  16. 16.
    Katz JN, Barrett J, Liang MH, Kaplan H, Roberts W, Baron JA. Utilization of rheumatology physician services by the elderly. Am J Med. 1998;105(4):312–8.PubMedPubMedCentralGoogle Scholar
  17. 17.
    LaVeist TA, Morgan A, Arthur M, Plantholt S, Rubinstein M. Physician referral patterns and race differences in receipt of coronary angiography. Health Serv Res. 2002;37(4):949–62.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Rastogi S, Johnson TT, Hoefell EM, Drewery MP Jr. The black population: 2010 – 2011. Accessed 8 May 2019.
  19. 19.
    Jha A, Orav E, Li Z, Epstein A. Concentration and quality of hospitals that care for elderly black patients. Arch Intern Med. 2007;167(11):1177–82.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Roby D, Nicholson G, Kominski G. African Americans in commercial HMO’s more likely to delay prescription drugs and use emergency room. Policy Brief UCLA Cent Health Policy Res. 2009;(PB2009-7):1–12.Google Scholar
  21. 21.
    Shen Y, Hsia R. Do patients hospitalized in high-minority hospitals experience more diversion and poorer outcomes? A retrospective multivariate analysis of Medicare patients in California. BMJ Open. 2016;6(3):e010263.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Hsia R, Asch S, Weiss R, Zingmond D, Liang L, Han W, McCreath H, Sun B. California hospitals serving large minority populations were more likely than others to employ ambulance diversion. Health Aff (Millwood). 2012;31(8):1767–76.Google Scholar
  23. 23.
    Joynt K, Orav E, Jha A. Patient race, site of care, and 30-day readmission rates among elderly Americans. JAMA. 2011;305(7):675–81.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Bime C, Poongkunran C, Borgstrom M, Natt B, Desai H, Parthasarathy S, Garcia J. Racial differences in mortality from severe acute respiratory failure in the United States, 2008–2012. Ann Am Thorac. 2016;12(12):2184–9.Google Scholar
  25. 25.
    Cruz-Flores S, Biller J, Elkind M, et al. Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(7):2091–116.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Aparicio H, Carr B, Kasner S, Kallan M, Albright K, Kleindorfer D, Mullen M. Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers. J Am Heart Assoc. 2015;4(10):e001877.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Amponsah M, Benjamin E, Magnani J. Atrial fibrillation and race – a contemporary review. Curr Cardiovasc Risk Rep. 2013;7(5):336. Scholar
  28. 28.
    Willson M, Neumiller J, Sclar D, Robison L, Skaer T. Ethnicity/race, use of pharmacotherapy, scope of physician-ordered cholesterol screening, and provision of diet/nutrition or exercise counseling during office-based visits by patients with hyperlipidemia. Am J Cardiovasc Drugs. 2010;10(2):105–8.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Lefebvre K, Chevan J. The persistence of gender and racial disparities in vascular lower extremity amputation: an examination of HCUP-NIS data (2002–2011). Vasc Med. 2015;20(1):51–9.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Holman K, Henke P, Dimick J, Birkmeyer J. Racial disparities in the use of revascularization before leg amputation in medicare patients. J Vasc Surg. 2011;54(2):420–6, 426.e1.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Goljo E, Parasher A, Iloreta A, Shrivastava R, Govindaraj S. Racial, ethnic, and socioeconomic disparities in pituitary surgery outcomes. Laryngoscope. 2016;126(4):808–14.Google Scholar
  32. 32.
    Schoenfeld A, Tipirneni R, Nelson J, Carpenter J, Iwashyna T. The influence of race and ethnicity on complications and mortality after orthopedic surgery: a systematic review of the literature. Med Care. 2014;52(9):842–51.Google Scholar
  33. 33.
    Sleder A, Tackett S, Cerasale M, Mittal C, et al. Socioeconomic and racial disparities: a case-control study of patients receiving transcatheter aortic valva replacement for severe aortic stenosis. J Racial Ethn Health Disparities. 2017;4(6):1189–94.Google Scholar
  34. 34.
    Zarkowsky D, Arhuidese I, Hicks C, et al. Racial/ethnic disparities associated with initial hemodialysis access. JAMA Surg. 2005;150(6):529–36.Google Scholar
  35. 35.
    Nguyen G, Chong C, Chong R. National estimates of the burden of inflammatory bowel disease among racial and ethnic groups in the United States. J Crohns Colitis. 2014;8(4):288–95.Google Scholar
  36. 36.
    Woods E, Bhaumik U, Sommer S, et al. Community asthma initive to improve health outcomes and reduce disparities among children with asthma. MMWR Suppl. 2016;65(1):11–20.Google Scholar
  37. 37.
    Gilligan A, Malone D, Warholak T, Armstrong E. Racial and ethnic disparities in Alzheimer’s disease pharmacotherapy exposure: an analysis across four state Medicaid populations. Am J Geriatr Pharmacother. 2012;10(5):303–12.Google Scholar
  38. 38.
    Sclar D, Robison L, Schmidt J, Bowen K, Castillo L, Oganov A. Diagnosis of depression and use of antidepressant pharmacotherapy among adults in the United States: does a disparity persist by ethnicity/race? Clin Drug Investig. 2012;32(2):139–44.Google Scholar
  39. 39.
    Sin M. Lung cancer disparities and African Americans. Public Health Nurs. 2017;34(4):359–62.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Ryan B. Lung cancer health disparities. Carcinogenesis. 2018;39(6):741–51.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Estevez J, Yang J, Leong J, et al. Clinical features associated with survival outcome in African American patients with hepatocellular carcinoma. Am J Gastroenterol. 2018;114:80. CrossRefGoogle Scholar
  42. 42.
    Busch E, Galanko J, Sandler R, Goel A, Keku T. Lifestyle factors, colorectal tumor methylation, and survival among African Americans and European Americans. Sci Rep. 2018;8:9470.Google Scholar
  43. 43.
    Collins Y, Holcomb K, Chapman-Davis E, Khabele D, Farley J. Gynecologic cancer disparities: a report from the health disparities taskforce of the Society of Gynecologic Oncology. Gynecol Oncol. 2014;133(2):353–61.PubMedPubMedCentralGoogle Scholar
  44. 44.
    DeSantis C, Fedewa S, Sauer A, et al. Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin. 2015;66:31–42.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Williams V, Awasthi S, Fink A, et al. African American men and prostate cancer-specific mortality: a competing risk analysis of a large institutional cohort, 1989–2015. Cancer Med. 2018;7(5):2160–71.PubMedPubMedCentralGoogle Scholar
  46. 46.
    Ragin C, Langevin S, Marzouk M, Grandis J, Taioli E. Determinants of head and neck cancer survival by race. Head Neck. 2011;33(8):1092–8.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Megwalu U, Ma Y. Racial disparities in oropharyngeal cancer survival. Oral Oncol. 2017;65:33–7.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Fiala M, Wildes T. Racial disparities in treatment use for multiple myeloma. Cancer. 2017;123(9):1590–6.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Khan I, Shergill A, Saraf S, et al. Outcome disparities in Caucasian and non-Caucasian patients with myeloproliferative neoplasms. Clin Lymphoma Myeloma Leuk. 2016;16(6):350–7.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Al-Qurayshi Z, Randolph G, Srivastav S, Aslam R, Friedlander P, Kandil E. Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope. 2016;126(9):2194–9.Google Scholar
  51. 51.
    Megwalu U, Saini A. Racial disparities in papillary microcarcinoma survival. J Laryngol Otol. 2017;131(1):83–7.Google Scholar
  52. 52.
    Kiechle J, Abouassaly R, Gross C, et al. Racial disparities in partial nephrectomy persist across hospital types: results from a population-based cohort. Urology. 2016;90:69–74.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Gregory L. Hall
    • 1
  1. 1.Partnerships for Urban HealthCleveland State UniversityClevelandUSA

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