Improving Care and Outcomes of Uninsured Persons with Chronic Disease … Now
Authors: Marshall H. Chin
Journal: Annals of Internal Medicine (2008)

Editorials5 August 2008Improving Care and Outcomes of Uninsured Persons with Chronic Disease … NowMarshall H. Chin, MD, MPHMarshall H. Chin, MD, MPHFrom The University of Chicago, Chicago, IL 60637.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-3-200808050-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Chronic disease kills, and uninsured persons with chronic disease are particularly vulnerable to poor outcomes. In this issue, Wilper and colleagues (1) report that an estimated 11.4 million working-age Americans with cardiovascular disease, hypertension, diabetes, hypercholesterolemia, pulmonary disease, and cancer do not have health insurance.The usual clarion call about the uninsured is to expand access to insurance. Health care insurance reform is necessary for good care for chronic disease, but it will not be sufficient unless it is coupled with quality improvement efforts targeting the reasons that vulnerable populations with access to care often do not receive optimal care. ...References1. Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU. A national study of chronic disease prevalence and access to care in uninsured U.S. adults. Ann Intern Med. 2008;149:170-6. LinkGoogle Scholar2. Sequist TD, Ayanian JZ, Marshall R, Fitzmaurice GM, Safran DG. Primary-care clinician perceptions of racial disparities in diabetes care. J Gen Intern Med. 2008;23:678-84. [PMID: 18214625] CrossrefMedlineGoogle Scholar3. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19:101-10. [PMID: 15009789] CrossrefMedlineGoogle Scholar4. Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. J Gen Intern Med. 2007;22:1231-8. [PMID: 17594129] CrossrefMedlineGoogle Scholar5. Smith WR, Betancourt JR, Wynia MK, Bussey-Jones J, Stone VE, Phillips CO, et al. Recommendations for teaching about racial and ethnic disparities in health and health care. Ann Intern Med. 2007;147:654-65. [PMID: 17975188] LinkGoogle Scholar6. Chin MH, Chien AT. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006;15:79-80. [PMID: 16585103] CrossrefMedlineGoogle Scholar7. Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S-28S. [PMID: 17881624] CrossrefMedlineGoogle Scholar8. Schlotthauer AE, Badler A, Cook SC, Pérez DJ, Chin MH. Evaluating interventions to reduce health care disparities: an RWJF program. Health Aff (Millwood). 2008;27:568-73. [PMID: 18332515] CrossrefMedlineGoogle Scholar9. Fisher TL, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions using culture to narrow racial disparities in health care. Med Care Res Rev. 2007;64:243S-82S. [PMID: 17881628] CrossrefMedlineGoogle Scholar10. Chin MH, Drum ML, Guillen M, Rimington A, Levie JR, Kirchhoff AC, et al. Improving and sustaining diabetes care in community health centers with the health disparities collaboratives. Med Care. 2007;45:1135-43. [PMID: 18007163] CrossrefMedlineGoogle Scholar11. Landon BE, Hicks LS, O'Malley AJ, Lieu TA, Keegan T, McNeil BJ, et al. Improving the management of chronic disease at community health centers. N Engl J Med. 2007;356:921-34. [PMID: 17329699] CrossrefMedlineGoogle Scholar12. Chien AT, Chin MH, Davis AM, Casalino LP. Pay for performance, public reporting, and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007;64:283S-304S. [PMID: 17881629] CrossrefMedlineGoogle Scholar13. Huang ES, Zhang Q, Brown SE, Drum ML, Meltzer DO, Chin MH. The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers. Health Serv Res. 2007;42:2174-93. [PMID: 17995559] CrossrefMedlineGoogle Scholar14. Huang ES, Brown SE, Zhang JX, Kirchhoff AC, Schaefer CT, Casalino LP, et al. The cost consequences of improving diabetes care: the community health center experience. Jt Comm J Qual Patient Saf. 2008;34:138-46. [PMID: 18419043] MedlineGoogle Scholar15. Zhang JX, Huang ES, Drum M, Kirchhoff AC, Schlicting JA, Schaefer CT, et al. The quality of diabetes care by insurance status at community health centers. Am J Public Health. 2008. [Forthcoming]. Google Scholar16. Werner RM, Goldman LE, Dudley RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA. 2008;299:2180-7. [PMID: 18477785] CrossrefMedlineGoogle Scholar17. Dewan S, Sack K. A safety-net hospital falls into financial crisis. New York Times. 8 January 2008. Front page, News. Google Scholar18. American College of Physicians. The Advanced Medical Home: A Patient-Centered, Physician-Guided Model of Health Care. A Policy Monograph. Philadelphia: American Coll of Physicians; 2006. Google Scholar Author, Article, and Disclosure InformationAuthors: Marshall H. Chin, MD, MPHAffiliations: From The University of Chicago, Chicago, IL 60637.Grant Support: Dr. Chin is supported by a National Institute of Diabetes and Digestive and Kidney Diseases Midcareer Investigator Award in Patient-Oriented Research (K24 DK071933) and a Diabetes Research and Training Center (P60 DK20595).Disclosures:Grants received: Director of the Robert Wood Johnson Foundation Finding Answers: Disparities Research for Change National Program Office.Corresponding Author: Marshall H. Chin, MD, MPH, The University of Chicago, Section of General Internal Medicine, 5841 South Maryland Avenue, MC 2007, Chicago, IL 60637; e-mail, [email protected]bsd.uchicago.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults Andrew P. Wilper , Steffie Woolhandler , Karen E. Lasser , Danny McCormick , David H. Bor , and David U. 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