Skip to main content
NCBI home page
Transactions of the American Clinical and Climatological Association logoLink to Transactions of the American Clinical and Climatological Association
. 1996;107:226–237.

Cultural competence--an essential hybrid for delivering high quality care in the 1990's and beyond.

R J Lavizzo-Mourey 1, E MacKenzie 1
PMCID: PMC2376550  PMID: 8725573

Abstract

Establishing guidelines for culturally competent medical care will help all physicians to fulfill their mandate to meet the health care needs of the individual patient as well as of patient populations, and to lower costs by encouraging a healing partnership with the patient, thus increasing patient responsibility for his or her own health. Being culturally sensitive is not enough. Nor is simply classifying patients according to race adequate. Many researchers in social science and health services increasingly agree that race in our heterogeneous U.S. population has limited biological meaning and more often than not is just a poor proxy for culture or socioeconomic status. Guidelines and quality indicators that seek to measure and improve cultural competence must take into account, in an integrated fashion, these three necessary components in the delivery of high-quality services to populations: 1) the health-related cultural factors; 2) the incidence and prevalence of diseases in the population; and 3) treatment outcomes peculiar to that population. To be culturally competent is to incorporate and integrate these critical factors into caring for diverse populations. If health care systems, individually and collectively, are to provide care of high quality that is cost-effective to all populations, researchers and funders of research must invest in an aggressive agenda that pursues two directions: the validation of existing quality indicators in minority populations, and the development of new quality indicators that assess the organization's ability to develop culturally competent care. Only in this way will those of us in the medical profession be able to fulfill our calling to relieve suffering without discriminating against some populations.

Full text

PDF
226

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson R. M., Herman W. H., Davis J. M., Freedman R. P., Funnell M. M., Neighbors H. W. Barriers to improving diabetes care for blacks. Diabetes Care. 1991 Jul;14(7):605–609. doi: 10.2337/diacare.14.7.605. [DOI] [PubMed] [Google Scholar]
  2. Blackhall L. J., Murphy S. T., Frank G., Michel V., Azen S. Ethnicity and attitudes toward patient autonomy. JAMA. 1995 Sep 13;274(10):820–825. [PubMed] [Google Scholar]
  3. Bowen O. R. Shattuck lecture--what is quality care? N Engl J Med. 1987 Jun 18;316(25):1578–1580. doi: 10.1056/NEJM198706183162505. [DOI] [PubMed] [Google Scholar]
  4. Carrese J. A., Rhodes L. A. Western bioethics on the Navajo reservation. Benefit or harm? JAMA. 1995 Sep 13;274(10):826–829. [PubMed] [Google Scholar]
  5. Coffey E., Moscovice I., Finch M., Christianson J. B., Lurie N. Capitated Medicaid and the process of care of elderly hypertensives and diabetics: results from a randomized trial. Am J Med. 1995 Jun;98(6):531–536. doi: 10.1016/s0002-9343(99)80011-4. [DOI] [PubMed] [Google Scholar]
  6. Cooper R. S. A case study in the use of race and ethnicity in public health surveillance. Public Health Rep. 1994 Jan-Feb;109(1):46–52. [PMC free article] [PubMed] [Google Scholar]
  7. Diabetes in Hispanic Americans. A symposium. Bethesda, Maryland, 23-24 May 1988. Diabetes Care. 1991 Jul;14(7):615–705. [PubMed] [Google Scholar]
  8. Eisenberg D. M., Kessler R. C., Foster C., Norlock F. E., Calkins D. R., Delbanco T. L. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993 Jan 28;328(4):246–252. doi: 10.1056/NEJM199301283280406. [DOI] [PubMed] [Google Scholar]
  9. Friedman E. A. Diabetic nephropathy in blacks. Transplant Proc. 1993 Aug;25(4):2431–2432. [PubMed] [Google Scholar]
  10. Gibaldi M. Ethnic differences in the assessment and treatment of disease. Pharmacotherapy. 1993 May-Jun;13(3):170–176. [PubMed] [Google Scholar]
  11. Gregg J., Curry R. H. Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening program. Soc Sci Med. 1994 Aug;39(4):519–526. doi: 10.1016/0277-9536(94)90094-9. [DOI] [PubMed] [Google Scholar]
  12. Koenig J. Q., Costa L. G., Kaylor G. Lymphocyte beta-adrenoceptors, asthma, and ethnicity. Lancet. 1992 Sep 19;340(8821):738–738. doi: 10.1016/0140-6736(92)92285-n. [DOI] [PubMed] [Google Scholar]
  13. LaVeist T. A. Beyond dummy variables and sample selection: what health services researchers ought to know about race as a variable. Health Serv Res. 1994 Apr;29(1):1–16. [PMC free article] [PubMed] [Google Scholar]
  14. Lang C. C., Stein C. M., Brown R. M., Deegan R., Nelson R., He H. B., Wood M., Wood A. J. Attenuation of isoproterenol-mediated vasodilatation in blacks. N Engl J Med. 1995 Jul 20;333(3):155–160. doi: 10.1056/NEJM199507203330304. [DOI] [PubMed] [Google Scholar]
  15. McDaniel D. O., Alarcón G. S., Pratt P. W., Reveille J. D. Most African-American patients with rheumatoid arthritis do not have the rheumatoid antigenic determinant (epitope) Ann Intern Med. 1995 Aug 1;123(3):181–187. doi: 10.7326/0003-4819-123-3-199508010-00004. [DOI] [PubMed] [Google Scholar]
  16. Reiser S. J. The era of the patient. Using the experience of illness in shaping the missions of health care. JAMA. 1993 Feb 24;269(8):1012–1017. doi: 10.1001/jama.269.8.1012. [DOI] [PubMed] [Google Scholar]
  17. Robinson R. G., Kessler L. G., Naughton M. D. Cancer awareness among African Americans: a survey assessing race, social status, and occupation. J Natl Med Assoc. 1991 Jun;83(6):491–497. [PMC free article] [PubMed] [Google Scholar]
  18. Saunders E. Hypertension in African-Americans. Circulation. 1991 Apr;83(4):1465–1467. doi: 10.1161/01.cir.83.4.1465. [DOI] [PubMed] [Google Scholar]
  19. Washington A. W. Moving toward cultural competence in the transplant milieu. Transplant Proc. 1993 Aug;25(4):2499–2501. [PubMed] [Google Scholar]
  20. Wood A. J., Zhou H. H. Ethnic differences in drug disposition and responsiveness. Clin Pharmacokinet. 1991 May;20(5):350–373. doi: 10.2165/00003088-199120050-00002. [DOI] [PubMed] [Google Scholar]

Articles from Transactions of the American Clinical and Climatological Association are provided here courtesy of American Clinical and Climatological Association

RESOURCES