Organisational efforts to improve quality while reducing healthcare disparities: the case of breast cancer screening among Arab women in Israel.
| Autor: | Wilf-Miron R; Department for Quality Promotion in Health Care, Maccabi Healthcare Services, Tel Aviv 68125, Israel. rachel_m@mac.org.il, Galai N, Gabali A, Lewinhoff I, Tov OS, Lernau O, Shemer J |
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| Jazyk: | angličtina |
| Zdroj: | Quality & safety in health care [Qual Saf Health Care] 2010 Oct; Vol. 19 (5), pp. e36. Date of Electronic Publication: 2010 Jun 17. |
| DOI: | 10.1136/qshc.2008.029645 |
| Abstrakt: | Objectives: (1) To improve quality and equity by increasing utilisation of mammography screening among Israeli Arab women. (2) To explore effectiveness of designing interventions with a combined top-down and bottom-up approach. Design: Retrospective study at two periods of time: 2004--intervention's preliminary stages; 2005--intervention's implementation. Setting: Maccabi Healthcare Services (MHS), an Israeli health plan serving 1.7 million members at study period; 7% of them are Arabs by 139 branches, 13 of which serve Arabs exclusively. MACRO-ORGANISATIONAL INTERVENTION (TOP DOWN): Development of a computerised Mammography Promotion System, phone contacts with non-respondents and intraorganisational reporting of screening rates. INTENSIVE INTERVENTION (BOTTOM UP): A local analysis of barriers to care and implementation of tailored solutions. This intervention was initiated and documented in three Arab branches, with spillover to the entire Arab sector. MEASURE DEFINITION: Biennial breast cancer (BC) screening of eligible women. Improvement measures Changes in BC screening rates in Arabs and comparisons with overall MHS BC screening rates for 2004 and 2005. Results: In 2005, average BC screening rates in Arab branches increased from 26.7% to 46.2% (73% improvement), while overall MHS screening rates increased from 49.0% to 63.1% (29% improvement). Analysis of the relative differences between 2004 and 2005 BC screening rates indicated statistically significant differences (p<0.006) in rates between the Arab and other branches. These results did not change after adjustment for branch size, region and branch average age. Conclusions: Combined top-down interventions and bottom-up initiatives are effective for formulating programmes to reduce inequality. |
| Databáze: | MEDLINE |
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