Closing the gap "Disparity in Native Hawaiian cardiac care".
OBJECTIVE
Queen's Heart, the cardiac service line at the Queen's Medical Center (QMC), Honolulu, Hawaii, recognizes the importance of closing the health disparity gap that affects the Native Hawaiian population. The purpose of this study was to examine the process and outcomes of health care among Native Hawaiians with heart disease, and to evaluate the impact of a multidisciplinary, culturally sensitive effort to improve quality of care. An inpatient program was created by assembling a team of practitioners who have an affinity for Native Hawaiian culture to address the health care of the Native Hawaiian people.


METHODS
All Native Hawaiian patients who were admitted to The Queen's Medical Center from January 2007 to December 2008 became participants of the program. Baseline outcomes data for cardiac core measures, length of stay, 30 day readmission rates, and adverse events were reviewed by the team before the study was initiated. Educational materials were developed to provide culturally specific disease management information to patients and family members. The patient educators and discharge counselors provided patients with the education and tools they needed to engage in self care management. Heart failure disease management ensured that all Native Hawaiian patients receive appropriate quality care, individualized heart failure education, and a definitive plan for out patient follow up. The Integrative Care Program provided a holistic perspective of healing.


RESULTS
All quality indicators for Native Hawaiian patients with cardiac disease have improved. Patient satisfaction rates have remained at the 99th percentile. There has been a marked improvement in adverse events following percutaneous coronary interventions (PCI) for Native Hawaiian patients. Readmissions that occurred in less than 30 days for patients admitted with myocardial infarctions and heart failure have improved and are now essentially the same as all other patient populations.


CONCLUSIONS
Culturally sensitive and patient centered care, delivered by the team of specialists from Queen's Heart, has allowed patients to incorporate cultural preferences into their care and recovery. Readmission rates have decreased, mortality rates have improved, and patient and family satisfaction is enhanced.
Cook
Ann
A
The Queen's Medical Center– Queen’s Heart, 1301 Punchbowl Street, Honolulu, HI 96813, USA. ancook@queens.org
Grothaus
Coraleen T
CT
Gutierrez
Carol E
CE
Kehoe
Kimberly A
KA
Valentin
Mona R
MR
D002300:Cardiac Care Facilities; D003469:Culture; D019468:Disease Management; D005260:Female; D006254:Hawaii; D054625:Healthcare Disparities; D006331:Heart Diseases / Q000208:ethnology* / Q000628:therapy; D006801:Humans; D007902:Length of Stay; D008297:Male; D054525:Minority Health; D044468:Native Hawaiian or Pacific Islander; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration*; D012648:Self Care