Literature Review on Effective Sex- and Gender-Based Systems/Models of Care

Table of Contents

• SEX-BASED DIFFERENCES
• GENDER-BASED DIFFERENCES
• QUALITY IN GENDER-BASED CARE

• ACCESS TO HEALTHCARE
• The decision to seek care
• Barriers to care-seeking
• Entry to the healthcare system
• Fragmentation of care
• Use of services
• ACCESS TO HEALTHCARE, OTHER FACTORS
• Variations by race and ethnicity
• Variations by socioeconomic status
• Variations by geography
• Variations by sexual orientation
• QUALITY AND CONTENT OF HEALTHCARE
• Sex-based models of healthcare
• Research issues in examining sex- and gender-based differences in healthcare
• Differences in outcomes
• Differences in diagnosis or referral rates
• Differences in overall quality of care
• Differences with unspecified clinical significance
• Summary opinions: Are there quality differences?
• QUALITY OF HEALTHCARE, OTHER FACTORS
• Variations by race and ethnicity
• Variations by socioeconomic status
• Variations by geography
• Variations by sexual orientation
• Variations by disability status
• CONCLUSIONS

• OVERVIEW OF APPROACHES
• Respect cultural values and implement cultural competency programs
• Use community health workers
• Reach people where they are
• Use appropriate language
• Model behaviors
• Addressing other needs
• Use of follow-up reminders
• EXAMPLES OF PROGRAMS TO REACH THE UNDERSERVED
• St. Agnes Nurses Center
• New Leaf ... Choices for Healthy Living
• WISEWOMAN
• Grady Memorial Hospital
• Magnolia Project
• Fitting in Fitness for Life
• WomanKind
• Models used by CoEs
• EFFECTIVENESS INFORMATION
• Specific project evaluations
• Large-scale analyses of what works
• CONCLUSIONS

• PROBLEMS IN THE U.S. HEALTHCARE SYSTEM
• Cost and inefficiency
• Disparities
• Reduced quality of care
• POTENTIAL BENEFITS OF A SYSTEMS APPROACH
• Improved quality of care
• Reduced disparities
• Reduced fragmentation
• Reduced duplication of services
• Improved access
• Improved incentives
• MODELS AND POTENTIAL PARTNERS TO MOVE TOWARD SYSTEMS-LEVEL CHANGE
• Patient-centered care approach
• Family-centered care movement
• Consumer-driven healthcare
• Pay-for-performance systems
• TRENDS IN HEALTH INSURANCE COVERAGE
• Overall coverage patterns
• Sex- and gender-based differences in coverage patterns
• Predictors of insurance coverage
• Trends among the uninsured
• Health implications of being uninsured
• Variations in coverage by race and ethnicity
• Variations in coverage for gays and lesbians
• Variation in coverage for rural residents
• TRENDS IN COSTS
• Overall findings related to out-of-pocket costs
• Sex- and gender-based differences in out-of-pocket costs
• Sex- and gender-based trends in out-of-pocket costs for older adults
• Other cost trends
• CONCLUSIONS

• CENTERS OF EXCELLENCE
• Indiana University
• Yale University*
• Cross-cutting findings from studies of multiple CoEs
• COMMUNITY CENTERS OF EXCELLENCE
• Implementing CCOEs
• SELECTED OTHER FEDERAL WOMEN'S HEALTH PROGRAMS
• CDC WISEWOMAN
• Department of Veterans Affairs
• Department of Defense
• SELECTED NON-FEDERAL WOMEN'S HEALTH PROGRAMS BASED IN THE UNITED STATES
• Columbia University Center for Women's Health
• University of Washington Woman's Health Center
• Sutter Health
• SELECTED WOMEN'S HEALTH PROGRAMS BASED OUTSIDE THE UNITED STATES
• Canada
• Brazil
• Thailand
• HEALTHCARE MODELS THAT DESCRIBE POSSIBLE APPROACHES TO CHANGE
• Chronic care model
• Evidence-based behavioral interventions
• Local health information infrastructure
• Traumatic brain injury
• CONCLUSIONS

• OVERALL TRENDS IN WOMEN'S HEALTHCARE
• Women's health centers are becoming more popular and prestigious
• Trends in who goes to women's centers
• Evaluations of women's centers
• CENTERS OF EXCELLENCE
• Who goes to CoEs
• Quality of care provided by CoEs
• Barriers to good care
• COMMUNITY CENTERS OF EXCELLENCE
• Evaluations of CCOEs
• SELECTED OTHER FEDERAL WOMEN'S HEALTH PROGRAMS
• Department of Veterans Affairs
• CDC WISEWOMAN
• NIH BIRCWH
• NIH SCOR
• SELECTED NON-FEDERAL WOMEN'S HEALTH PROGRAMS BASED IN THE UNITED STATES
• Columbia University's Center for Women's Health
• SELECTED WOMEN'S HEALTH PROGRAMS BASED OUTSIDE THE UNITED STATES
• Canada
• Thailand
• Brazil
• Australia
• The Netherlands
• THE MOVEMENT TOWARD GENDER-BASED MEDICINE
• Trends in gender programs
• Evaluations of gender programs
• TRACKING SUCCESS
• Data collection issues
• Suggested approaches to data collection and analysis
• Recent progress in data collection
• CONCLUSIONS

• CHANGES IN CLINICAL CARE
• Importance of the primary care setting and integrated care
• Implementing changes in clinical care
• INCREASED FEMALE LEADERSHIP
• Number of women in healthcare
• Benefits of women in leadership positions
• Barriers to women's leadership
• Efforts to create women leaders
• INCREASED MINORITY LEADERSHIP
• Trends in minority leadership
• Benefits of minority leadership
• MALE VS. FEMALE DOCTORS
• Patient interactions
• Significance of differences
• GENDER MATCH BETWEEN DOCTOR/PATIENT
• Patient preferences
• Quality of care differences favoring gender concordance
• Quality of care differences favoring gender discordance
• CURRICULUM CHANGES
• How curriculum changes occur
• Progress in medical school curriculums
• Progress in pharmaceutical curriculums
• Progress in public health curriculums
• Progress in nursing curriculums
• Progress in training for researchers
• Progress in other nations
• WHERE EXISTING CAREGIVERS NEED TRAINING ON SEX DIFFERENCES
• Knowledge gaps related to sex- and gender-based treatment
• Knowledge gaps related to patient gender and the discussion of symptoms
• Gender-specific guidelines or practices
• OTHER FACTORS
• Satisfaction with care
• CONCLUSIONS

• MEN'S USE OF HEALTHCARE
• Men are less likely to use healthcare services
• How men access care
• BARRIERS TO MEN'S CARE-SEEKING
• Men don't see themselves as needing care
• Economic barriers
• Fear, denial, and shame
• Poor communication
• Racism/disrespect
• Measuring men's care barriers
• MASCULINITY AND HEALTHCARE
• Risk-taking
• Delay of care-seeking
• APPROACHES TO GETTING MEN IN FOR CARE
• Women as gatekeepers to men's care
• Men's preventive health emphasis
• Creating more appropriate settings for men
• MODEL PROGRAMS
• WK Kellogg Foundation
• New Generation Health Center
• Nuestros Hombres
• CONCLUSIONS

Current as of March 2007