Pipeline programs in the health professions, part 1: preserving diversity and reducing health disparities.

BACKGROUND: Racial and ethnic minorities are underrepresented in the health professions. Affirmative action and educational pipeline programs play a vital role in increasing the diversity of health professions, addressing educational opportunity gaps, and reducing health disparities. Part 1 of this 2-part series discusses the need for educational pipeline programs to assist underrepresented minorities (URMs) in entering the health professions and the importance of these programs in developing a cadre of diverse providers to reduce health care inequality. METHODS: Part 1 presents an overview of diversity in the medical and health care workforce, educational enrichment programs, key components of successful pipeline programs, and notable pipeline examples for underrepresented students at the University of Nebraska Medical Center. Recommendations for improving and developing pipeline programs are also included. Part 2 reviews affirmative action case law and legislation along with recommendations for maintaining and reviewing diversity pipeline programs in light of recent anti-affirmative action challenges. CONCLUSION: Pipeline programs are an important strategy for addressing the shortage of URMs in the health professions. Anti-affirmative action initiatives threaten the existence of these student preparation programs and the ability of our nation to produce physicians of color and other health care providers who are more likely to serve in underrepresented communities and work to reduce related health disparities. Programs at universities and academic medical centers must develop innovative partnerships with underserved communities, adopt strategies that demonstrate a strong commitment to increasing racial and ethnic minorities in the health professions, and develop viable funding mechanisms to support diversity enrichment programs.

Pipeline programs in the health professions, part 2: the impact of recent legal challenges to affirmative action.

BACKGROUND: Despite recent challenges to educational pipeline programs, these academic enrichment programs are still an integral component in diversifying the health professions and reducing health disparities. This is part 2 of a 2-part series on the role of pipeline programs in increasing the number of racial and ethnic minorities in the health professions and addressing related health disparities. Part 1 of this series looked at the role of pipeline programs in achieving a diverse health professional workforce and provided strategies to expand pipeline programs. METHODS: This paper presents an historical overview of affirmative action case law, anti-affirmative action legislation, and race-conscious and race-neutral admission programs in education. Additionally, part 2 reviews current legal theory and related law that impact the diversity and cultural competence pipeline programming at higher-education institutions. Finally, based on recommendations from a review of legal and other literature, the authors offer recommendations for reviewing and preserving diverse pipeline programs for health professional schools. CONCLUSION: Affirmative action is an essential legal means to ensure the diversity-related educational programs in the health profession educational programs. Anti-affirmative action legislation and state-sponsored antiaffirmative voter initiatives have the potential to limit the number of underrepresented minorities in the health professions and create even greater opportunity gaps and educational disparities. Therefore, we must shift the paradigm and reframe the dialogue involving affirmative action and move from debate to a collaborative discussion in order to address the historical and contemporary disparities that make affirmative action necessary today.

Developing an online prematriculation orientation program and its relation to student performance in the first class taken in medical school.

BACKGROUND: In 2004 the University of Nebraska College of Medicine developed an online prematriculation program, Fast Start, to introduce students to the environment and expectations in medical school. PURPOSE: This quantitative study was conducted to determine whether using Fast Start correlated with performance in the gross anatomy course. METHODS: A hierarchical regression analysis was used to correlate grades in gross anatomy with a set of common prediction variables and a variable for use of Fast Start. RESULTS: The results showed that the predictive power of the full model, including the Fast Start variable, was slightly stronger than for the reduced model. A separate model verified the absence of an interaction between Fast Start use and prior academic ability. CONCLUSIONS: The online Fast Start program provided an efficient and effective method of delivering a prematriculation student orientation experience; its use was associated with marginally improved performance in a medical school course.

Multicultural medicine and ensuring good health for all.

This article explores health disparities and the effects of race and ethnicity on health care quality. It emphasizes the importance of cross-cultural training and two areas that can make a difference in delivering health care services to minorities: 1) establishing national guidelines and standards for culturally competent care; and 2) improving the healthcare educational pipeline and incorporating cultural proficiency curriculum into all medical training. Information from this article was presented during Plenary Session 1 of the Fifth Annual Primary Care and Prevention Conference, September 21, 2005.

HEDIS prevention performance indicators, prevention quality assessment and Healthy People 2010.

The purposes of the study were to contrast actual prevention services needs with quality assurance indicators from the Health Employer Data Information System (HEDIS-Medicaid 3.0) and the goals and objectives of Healthy People 2010, to calculate allowable Medicaid reimbursement for comprehensive prevention services, and to describe patient expectations for prevention counseling. We obtained a convenience sample of all ages (under 17 years = 514, 18 years or older = 473), both sexes (male = 393, female = 594), and three racial/ethnic groups: African American = 687, White =173, Hispanic = 88 in a clinic that predominantly served Medicaid-insured patients. Participants 18 years of age and older were interviewed about expectations for preventive counseling. According to procedures rated A or B by the second United States Preventive Services Task Force (USPSTF), these patients had 11,504 service needs. Performance indicators from HEDIS-Medicaid 3.0 would have covered 2,571 (22%) while the goals and objectives of Healthy People 2010 would have covered 11,437 (99%). Allowable Medicaid reimbursement estimates for 100% coverage averaged USD $206.13 per person. A majority of patients in all race-sex groups expected counseling at least once per year. The results show that a focus on HEDIS-Medicaid 3.0 quality indicators in these patients would have been inconsistent with the goals and objectives of Healthy People 2010, that it would have promoted patient mistrust by failing to meet patient expectations, and that payment for 100% coverage of A and B USPFTF recommended preventive services at Medicaid rates would have constituted a small fraction of per capita yearly U.S. health care expenditures.

Racial/ethnic disparity and predictors of leisure-time physical activity among U.S. men.

OBJECTIVES: To examine racial/ethnic disparity in and predictors of leisure-time physical activity (LTPA) among men. METHODS: We used the National Health Interview Surveys (NHIS) 1999-2000 data, a multistage probability sampling design producing a U.S. representative sample of 23,459 adult males. Data were analyzed using multinomial logistic regression. RESULTS: The likelihood of engaging in irregular or regular LTPA was associated with younger age, being unmarried, lower household sizes, higher levels of education and income, home ownership, U.S. citizenship, perceived better health status, contact with a health professional within a year, being a non-smoker, living in the West, and residing in a midsize metropolitan statistical area. Hispanics were significantly less likely to engage in regular LTPA than Whites and higher percentages of Hispanics were physically inactive in almost all age and education groups when compared to other races. Disparity between Whites and Blacks was less pronounced. Non-citizen Hispanics were twice as likely to be inactive than citizens and White non-citizens were 40% more likely to be inactive than citizens. Conversely, Black citizens were 20% more likely to be inactive than non-citizens. CONCLUSIONS: Racial/ethnic disparities exist after accounting for socio-demographic characteristics. Not being a citizen exacerbates the disparity between Hispanic and White men. While disparity did exist between Black and White men, this gap was not as large as between Hispanic and White men. Health-seeking behaviors, such as contact with a health professional and non-smoking status are modifiable and influence men of all racial and ethnic backgrounds to engage in LTPA.