Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations
Abstract
The spectrum of knowledge that benefits radiologists and members of the radiology care team when interacting with and providing care for the growing pool of diverse, marginalized, and vulnerable patient populations is described and illustrated.
Although much attention has been paid to the reduction of disparities in health care within the United States, these issues continue to exist. Such efforts include increased focus on patient centeredness and cultural responsivity. These concepts are based on the recognition that diverse, marginalized, and vulnerable patients may possess different physical, psychologic, or social characteristics that contribute to their diversity and susceptibility. Such patients may face numerous obstacles and barriers when seeking medical care, including financial constraints, difficulties with communication, a limited understanding of how to navigate the health care system, and not feeling welcomed, respected, or safe. It is essential that the radiologist and members of the radiology care team understand and embrace patients’ unique characteristics to provide effective and appropriate care to all patients. This article illustrates the spectrum of knowledge that benefits radiologists and members of the radiology care team when interacting with and providing care for the growing pool of diverse, marginalized, and vulnerable patients.
©RSNA, 2018
References
- 1. . The challenge of serving and working with diverse populations in American hospitals. Divers Factor 2001;9:21–27.
- 2. . The need for a transformed clinical method. In: Steward M, Roter D, eds. Communicating with medical patients. London, England: Sage, 1989.
- 3. . The possibilities of patient-centered medicine. J R Coll Gen Pract 1969;17(82):269–276.
- 4. . Patient-centered medicine. A professional evolution. JAMA 1996;275(2):152–156.
- 5. Cultural competency and quality of care: obtaining the patient’s perspective. New York, NY: The Commonwealth Fund, 2006.
- 6. . Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc 2008;100(11):1275–1285.
- 7. . Health care experiences of limited English proficient Chinese and Vietnamese Americans. J Gen Intern Med 2003;18(suppl 1):184.
- 8. . Patient-physician relationships and racial disparities in the quality of health care. Am J Public Health 2003;93(10):1713–1719.
- 9. Perceptions of specific clinician behaviors linked to health care quality. Presented at AcademyHealth Annual Research Meeting, Boston, Mass, June 26–28, 2005.
- 10. . Racial differences in how patients perceive physician communication regarding cardiac testing. Med Care 2002;40(1 suppl):I27–I34.
- 11. Gerteis M, Edgman-Levitan S, Daley J, Delbanco T, eds. Through the patient’s eyes: understanding and promoting patient-centered care. San Francisco, Calif: Jossey-Bass, 1993.
- 12. . Racial and ethnic differences in a patient survey: patients’ values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care 2000;38(3):300–310.
- 13. . Patients’ perceptions of cultural factors affecting the quality of their medical encounters. Health Expect 2005;8(1):4–17.
- 14. Valued aspects of ambulatory care: comparing patients and providers based on office visit accounts. Presented at AcademyHealth Annual Research Meeting, Boston, Mass, June 26–28, 2005.
- 15. . A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Acad Med 2003;78(6): 577–587.
- 16. . Cross-cultural medicine at home. Minn Med 1992;75(3):15–17.
- 17. . Symptom expression and somatization among elderly Korean immigrants. J Clin Geropsychol 2000;6(3):199–212.
- 18. . Unconventional medicine in the United States: prevalence, costs, and patterns of use. N Engl J Med 1993;328(4):246–252.
- 19. . Empathy’s vital role in putting patients first. Radiology 2013;269(2):315–317.
- 20. Vulnerable populations: who are they? Am J Manag Care 2006;12(13 suppl):S348–S352.
- 21. . Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care: unequal treatment—confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press, 2003.
- 22.
Project Implicit . https://www.projectimplicit.net/index.html. Published 2011. Accessed January 2, 2018. - 23. . Accessibility of radiology equipment for patients with mobility disabilities. Hum Factors 2008;50(5):801–810.
- 24. ACR Guidance Document on MR Safe Practices: 2013. J Magn Reson Imaging 2013;37:501-530
- 25. . Improving healthcare access for people with visual impairment and blindness. BMJ 2012;344:e542.
- 26. . Caring for older adults in the radiology department: are you prepared? J Radiol Nurs 2007;26(1):11–14.
- 27. . Inequities in healthcare: a review of bias and discrimination in obesity treatment. Can J Diabetes 2013;37(3):205–209.
- 28. . Obese patients and radiography literature: what do we know about a big issue? J Med Radiat Sci 2015;62(2):132–141.
- 29. . The obese emergency patient: imaging challenges and solutions. RadioGraphics 2011;31(3):811–823.
- 30. . Post-traumatic stress disorder following disasters: a systematic review. Psychol Med 2008;38(4):467–480.
- 31. . Hurricane Katrina’s impact on the care of survivors with chronic medical conditions. J Gen Intern Med 2007;22(9):1225–1230.
- 32. . Coping in a calamity: radiology during the cloudburst at Leh. Indian J Radiol Imaging 2013;23(1):106–109.
- 33. Emergency imaging after a mass casualty incident: role of the radiology department during training for and activation of a disaster management plan. Br J Radiol 2016;89(1061): 20150984.
- 34. . Radiology of recreational drug abuse. RadioGraphics 2007;27(4):919–940.
- 35. . Management of the intoxicated patient in the emergency department. Relias. https://www.ahcmedia.com/articles/35285-management-of-the-intoxicated-patient-in-the-emergency-department. Published January 1, 1998. Accessed January 26, 2018.
- 36. . Quality healthcare for lesbian, gay, bisexual and transgender people: part 2—creating a welcoming and safe environment for LGBT people and families. Gay and Lesbian Medical Association Cultural Competence webinar series: part 2. https://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-health-disparities-solutions/GLMA_webinar_pt_2_nathan_levittFINAL_Compatibility_Mode.pdf. Accessed January 4, 2018.
- 37. . If you have it, check it: overcoming barrier to cervical cancer screening with patients on the female-to-male transgender spectrum. National LGBT Health Education Center. https://www.lgbthealtheducation.org/wp-content/uploads/Overcoming-Barriers-to-Cervical-Cancer-Screening.pdf. Published 2014. Accessed January 4, 2018.
- 38. . Breast imaging in the transgender patient. AJR Am J Roentgenol 2014;202(5): 1149–1156.
- 39. . Patient preferences for chaperone use during transvaginal sonography. Abdom Radiol (NY) 2016;41(2):324–333.
- 40. Geographic access to breast imaging for US women. J Am Coll Radiol 2014;11(9):874–882.
- 41. . A new clinic model for refugee health care: adaptation of cultural safety. Rural Remote Health 2012;12(1):1826.
- 42. . Understanding cultural diversity. http://www.ggalanti.org/cultural-diversity-in-healthcare/. Published 2016. Accessed January 29, 2018.
- 43. . Impact of socioeconomic status on ionizing radiation exposure from medical imaging in children. J Am Coll Radiol 2012;9(11): 799–807.
- 44. . How socioeconomic status affects patient perceptions of health care: a qualitative study. J Prim Care Community Health 2017;8(3):169–175.
- 45. . The role of rigorous scientific evaluation in the use and practice of complementary and alternative medicine. J Am Coll Radiol 2009;6(4):254–262.
- 46. The use of alternative and complementary medicine in radiology today. Radiol Manage 2000;22(1): 51–55.
- 47. . Commonly used dietary supplements on coagulation function during surgery. Medicines (Basel) 2015;2(3):157–185.
- 48. . One in five U.S. residents speaks foreign language at home, record 61.8 million: Spanish, Chinese, and Arabic speakers grew most since 2012. Center for Immigration Studies. https://cis.org/sites/cis.org/files/camarota-language.pdf. Published October 2014. Accessed August 23, 2018.
- 49. . Census 2000 summary file 3. https://www.census.gov/census2000/sumfile3.html. Published 2000. Accessed February 19, 2018.
- 50. . In the right words: addressing language and culture in providing health care. Issue Brief (Grantmakers Health) 2003;18(18):1–44.
- 51. . Hispanic patients’ double burden: lack of health care insurance and limited English. New York, NY: The Commonwealth Fund, 2003.
- 52. . Bridging language barriers in health care: public opinion survey of California immigrants from Latin America, Asia and the Middle East. Los Angeles, Calif: The California Endowment, 2003.
- 53. . Language as a communication barrier in medical care for Hispanic patients. Hisp J Behav Sci 1991;13(4):363–376.
- 54. . Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care 1998;36(10):1461–1470.
- 55. . A new method for evaluating the quality of medical interpretation. Med Care 2004;42(1):71–80.
- 56. . Patient centeredness in medical encounters requiring an interpreter. Am J Med 2000;108(6):470–474.
- 57. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics 2003;111(1):6–14.
- 58. . A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Soc Care Community 2003;11(1):45–54.
- 59. . Certification of health care interpreters in the United States: a primer, a status report, and considerations for national certification. https://ncihc.memberclicks.net/assets/certification_of_health_care_interpretors%20posted%20version.pdf. Published September 2006. Accessed August 23, 2018.
- 60. . Translation and interpretation services. Medicaid.gov website. https://www.medicaid.gov/medicaid/finance/admin-claiming/translation/index.html. Accessed August 23, 2018.
- 61. . Title 45: public welfare, Part 92.201. https://www.ecfr.gov/cgi-bin/text-idx?SID=dd8437f3cb5fa372a19760af17ffd573&mc=true&node=se45.1.92_1201&rgn=div8. Updated August 14, 2018. Accessed February 20, 2018.
- 62. . Imaging correctional facility patients. Radiol Technol 2011;82(5):447–463.
- 63. Verbal de-escalation of the agitated patient: consensus statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med 2012;13(1):17–25.
- 64. . Model for cultural diversity in the radiology department. Radiol Technol 1997;68(3):233–238.
- 65. Improving diversity, inclusion, and representation in radiology and radiation oncology part 2: challenges and recommendations. J Am Coll Radiol 2014;11(8):764–770.
- 66. . Imaging 3.0. https://www.acr.org/Practice-Management-Quality-Informatics/Imaging-3. Accessed August 23, 2018.
- 67. Radiology Cares. RSNA website. https://www.rsna.org/Radiology_Cares/. Published 2017. Accessed February 11, 2018.
Article History
Received: Feb 22 2018Revision requested: Mar 15 2018
Revision received: Apr 9 2018
Accepted: Apr 12 2018
Published online: Oct 10 2018
Published in print: Oct 2018