11/15/2018
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Despite progress, ethnic health disparities persist in Minnesota


By Jeremy Olson Star Tribune
Saturday January 13, 2018

Minnesotans of many ethnic backgrounds might have similar words for a colonoscopy — it’s colonoscopia in Spanish and koloskopi in Norwegian — but they vary dramatically in the rates at which they seek this important medical screening.

The state’s fourth annual health equity report, released Thursday by Minnesota Community Measurement, showed that, overall, 73 percent of adults ages 51 to 75 were up to date with colon cancer screening last year. But that rate dropped to 60 percent of Hispanics, 55 percent of American Indians and 27 percent of Somali natives.

The screening is one of eight measures the nonprofit group uses to track quality of care provided by the state’s medical clinics and whether Minnesota is making progress against its numerous ethnic health disparities.

The good news is that the overall rate for colon cancer screenings rose three percentage points from 2014, and that progress was partly driven by a sharp increase among Minnesotans who primarily speak Spanish.

Share of Minnesotans due for colon cancer screening who actually receive it
Sorted by preferred language of patients aged 51 to 75. Clinic groups in Minnesota are trying to address these disparities. The statewide average is 73 percent.

While 1 percent per year might not sound like dramatic progress, it means that thousands more Minnesotans are getting screened for a common and dangerous form of cancer and that doctors are figuring out how to appeal to different patient populations, said Julie Sonier, president of Minnesota Community Measurement.

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“Health care providers in general have been making efforts to address some of the gaps,” Sonier said, “in part by approaching patients who should be screened — but haven’t — with different kinds of messaging or highlighting what some of the other options are besides a colonoscopy.”

Sonier said it’s important to highlight disparities at a state and clinic level so doctors can examine their practices and see how they can improve their ability to work with minority groups. Clinics provided the deidentified patient data to the nonprofit organization for the report, which remains the nation’s most detailed evaluation of clinic performance by ethnic and racial groups.

Even top performers have disparities. HealthPartners clinics in the east metro had 67 percent of Spanish-speaking patients up to date with colon cancer screening last year, but their rate for patients overall was 76 percent. Screening can include a colonoscopy, a home stool test or other established methods.

HealthPartners responded to the disparity last year by identifying the primary language of patients and sending language-specific reminders to patients who were overdue for screening.

While people with family histories of colon cancer need colonoscopies, others don’t know that they can pursue other options that won’t cause them as much anxiety, said Dr. Rae Ann Williams, a HealthPartners regional medical director. Informing them through language-specific mailings has boosted the screening rate.

“The best screening test for a patient is the one that [he or she] will do,” Williams said.

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Disparities are more than a matter of social equity: They can affect all Minnesotans because poorer care for one population tends to mean higher costs paid by everyone through health insurance premiums and taxes for government-supported programs such as Medicaid.

Among the report’s most glaring disparities was the gap in optimal diabetes care between white patients, at 47 percent, and American Indian patients, at 24 percent.

This year’s equity report also showed differences in the way minority groups perceive their medical care. Minnesotans of Asian descent tended to have the best outcomes, in terms of screening rates and disease management, and yet they were more likely to dislike their doctors and clinics. For blacks, on the other hand, health outcomes were below average, and yet they tended to be happier with their doctors.

Positive patient experiences are an important sign of progress for blacks, due to historical mistrust of the health care system, said Stella Whitney-West, chief executive of the NorthPoint clinic in Minneapolis, which serves mostly minority patients. But the fact that the group remains in poorer overall health than others shows the important role of economic and social factors that are beyond a doctor’s control.

“Factors that have the most impact on health outcomes for African-American patients at NorthPoint cannot be addressed through clinical care alone,” she said.



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