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Fraser, Irene

Authors: Brach C, and Fraser I.
Title: Reducing Disparities through Cultural Competent Health Care: An Analysis of the Business Case.
Publication: Quality Management in Health Care 10(4):15-28.
Date: 2002
Abstract: The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted considerable interest in increasing the cultural competence of health care, both as an end in its own right and as a potential means to reduce disparities. Health care organizations have financial incentives to become culturally competent, but limitations inherent in these incentives must be overcome if cultural competence is to become widespread.
Topics: Markets, Minorities, Organizational Research, Public Policy, Purchasing.
Availability: AHRQ Publication No. 02-R081 is available from the AHRQ Publications Clearinghouse.

Authors: Brach C, Fraser I.
Title: Can cultural competency reduce ethnic and racial health disparities? A review and conceptual model.
Publication: Med Care Res Rev 57(Suppl 1):181-217.
Date: 2000
Abstract: This article investigates cultural competency's potential to reduce racial and ethnic health disparities through a review of both the cultural competency and disparities literatures and development of a conceptual model. It identifies nine major cultural competency techniques described in the literature (interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of indigenous community workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations). The authors model how cultural competency techniques could improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations that lead to good outcomes, thereby reducing disparities. The authors conclude that while there is substantial evidence to suggest that cultural competency should work, health systems have little evidence about which cultural competency techniques are in fact effective, and less evidence on when and how to implement them properly.
Topics: Minorities, Public Policy, Research Agenda.
Availability: AHRQ Publication No. 01-R007 is available from the AHRQ Publications Clearinghouse. Copies of this journal supplement can be ordered from the Kaiser Family Foundation (1-800-656-4533, publication #3072).

Authors: Brach C, Sanches L, Young D, et al.
Title: Wrestling with typology: Penetrating the "black box" of managed care by focusing on health care system characteristics.
Publication: Med Care Res Rev 57(Suppl 2):93-115.
Date: 2000
Abstract: This article investigates cultural competency's potential to reduce racial and ethnic health disparities through a review of both the cultural competency and disparities literatures and development of a conceptual model. It identifies nine major cultural competency techniques described in the literature (interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of indigenous community workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations). The authors model how cultural competency techniques could improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations that lead to good outcomes, thereby reducing disparities. The authors conclude that while there is substantial evidence to suggest that cultural competency should work, health systems have little evidence about which cultural competency techniques are in fact effective, and less evidence on when and how to implement them properly.
Topics: Minorities, Public Policy, Research Agenda.
Availability: AHRQ Publication No. 01-R014 is available from the AHRQ Publications Clearinghouse.

Authors: Fraser I, McNamara P.
Title: Employers: Quality takers or quality makers?
Publication: Med Care Res Rev 57(Suppl 2):33-52.
Date: 2000
Abstract: Available on PubMed®
Topics: Public Policy, Purchasers, Research Agenda.
Availability: AHRQ Publication No. 01-R012 is available from the AHRQ Publications Clearinghouse.

Authors: McNamara P, Caldwell B, Fraser I, et al.
Title: New contributions from the field of health services research.
Publication: Med Care Res Rev 57(Suppl 2):5-8.
Date: 2000
Abstract: Wide press coverage of a recent Institute of Medicine (IOM) study on patient safety problems broadened public understanding of a fundamental and discouraging finding from health services research: the quality of care in the United States varies greatly and cannot be presumed. The IOM report underscores another research finding offering guidance for those seeking to improve quality—the safety and quality of patient care can be no better than the system of care. Improvements in quality require a comprehensive and purposive set of system solutions based on scientific evidence about what works and what doesn't. This article summarizes seven others in a special supplement of Med Care Res Rev, drawn from two national meetings of health plans and health services researchers (Building Bridges 1999, 2000). The timely and actionable articles provide insights on organizational and institutional approaches to quality, and inform our future research agenda related to quality by identifying evidence gaps, offering design suggestions and identifying research priorities.
Topics: Managed Care, Public Policy, Research Agenda.

Authors: Fraser I, McNamara P, Lehman G, et al.
Title: The pursuit of quality by business coalitions: A national survey
Publication: Health Aff 18(6):158-65.
Date: 1999
Abstract: Available on PubMed®
Topics: Public Policy, Purchasing.
Availability: AHRQ Publication No. 00-R003 is available from the AHRQ Publications Clearinghouse.

Authors: Fraser I, Wong H, Arent J, et al.
Title: Building Bridges IV: Managed care research comes of age.
Publication: Med Care Res Rev 56(Suppl 2):5-12.
Date: 1999
Abstract: This article describes and contrasts the challenges and objectives facing attendees of the May 1998 conference, Building Bridges with those facing conference attendees of the inaugural Building Bridges conference held in April 1995. The conference was cosponsored by the American Association of Health Plans, AHCPR, Centers for Disease Control, and HMO Research Network. A brief overview of the articles presented in the special issue of Med Care Res Rev demonstrates just how far managed care research has evolved. Five of the most notable changes since the first Building Bridges conference are highlighted: (1) The two worlds of managed care and research are no longer distinct and separate. (2) The conference and the parties to the dialogue have grown substantially. (3) We have moved from broad concern about the impact of managed care to looking inside the black box. (4) Researchers are questioning established theories about how markets do and will work, with particular emphasis on the role of consumers and purchasers. (5) Continued progress in conducting and implementing managed care research will require new bridges and partnerships.
Topics: Managed Care, Research Agenda.

Authors: Simpson L, Fraser I.
Title: Children and managed care: What research can, can't, and should tell us about impact.
Publication: Medical Care Research and Review 56(Suppl 2):13-36.
Date: 1999
Abstract: The speed and ubiquity of the move from fee-for-service to managed care raises questions about how these changes affect children. This article examines: (1) The pace and context of the move to managed care for children. (2) Potential opportunities and challenges emerging from these changes. (3) Research findings on how managed care affects children. (4) Next steps for learning more.
The research review provides a consistent answer to whether managed care is good for children: it depends on what kind of managed care, which children, and under what circumstances. This finding suggests lessons for future research: (1) Focus on particular features of managed care. (2) Get inside the "black box" of managed care and examine providers. (3) Expand the portfolio of research on children; research on adults cannot "trickle down" to children. (4) Foster research partnerships and networks.
(5) Focus on poor and chronically ill children.
Topics: Children, Managed Care, Research Agenda.
Availability: AHCPR Publication No. 99-R062 is available from the AHRQ Publications Clearinghouse.

Authors: Fraser I, Chait E, Brach C.
Title: Promoting choice: Lessons from managed Medicaid programs.
Publication: Health Aff 17(5):165-73.
Date: 1998
Abstract: By examining the experiences of seven States with mandatory managed Medicaid programs, this article seeks to draw some lessons and raise research, policy, and operational questions about enrollee choice of health plans. The article explores the strategies States adopt to inform and facilitate choice, and what methods they use to assign individuals who do not make a choice in the time allotted. Differences are identified in the enrollment and education process that might account for some of the variation among States' rates of enrollees who choose a plan. Use of enrollment brokers and restrictions on marketing is also discussed.
Topics: Managed Care, Medicaid, Public Policy.
Availability: AHCPR Publication No. 98-R088 is available from the AHRQ Publications Clearinghouse.

Authors: Friedman B, Devers K, Hellinger F, et al.
Title: Carve outs and related models of contracting for speciality care: Framework and highlights of a workshop.
Publication: American Journal of Managed Care 4(Special Issue).
Date: 1998
Abstract: This article provides an overview of papers presented at a workshop sponsored by AHCPR in January, 1998. The papers, published in this special issue of the American Journal of Managed Care, focus on one set of strategies: the use of carve outs and related models of contracting for specialty care. The defining common feature of these contracts is that they engage providers and management entities different from those otherwise available to care for the same patients within a health plan. The other common feature of these arrangements is that they receive significant attention in the marketplace and almost no attention from research. The purpose of the workshop and this special issue of the American Journal of Managed Care is to identify what is known and not known about these arrangements and develop an agenda for future research.
Topics: Cost, Managed Care, Medicaid, Mental Health.
Availability: AHCPR Publication No. 98-R080 is available from the AHRQ Publications Clearinghouse.

Authors: Simpson L, Kamerow D, Fraser I.
Title: Pediatric guidelines and managed care: Who is using what and what difference does it make?
Publication: Pediatric Annals 27(4):234-40.
Date: 1998
Abstract: This article defines the use and value of guidelines, their role in improving the quality and outcomes of care, and the reasons some clinicians are skeptical of them. The article articulates the role of managed care organizations in driving the use of guidelines, and identifies the importance of the evidence base for child health interventions as well as efforts in progress to improve and expand this base.
Topics: Children, Managed Care.
Availability: AHCPR Publication No. 98-R081 is available from the AHRQ Publications Clearinghouse.

Author: Fraser I.
Title: Access to health care.
Publication: In Health Politics and Policy, edited by L. R. T. Littman. Albany, (NY): Delmar Publishers.
Date: 1997
Abstract: This article examines threats to health care access, dynamics of coverage, and three important trends affecting access to health care in America—the downsizing and decentralization of public programs and restructuring of the private health care market, increased enrollment in managed care organizations, and the greater power of purchasers.
Topics: Insurance, Managed Care, Markets, Purchasing.
Availability: AHCPR Publication No. 98-R003 is available from the AHRQ Publications Clearinghouse.

Author: Fraser I.
Title: Research on health care organizations and markets—The best and worst of times.
Publication: Health Services Research 32(5):669-78.
Date: 1997
Abstract: This article contains reflections from four short papers commissioned by AHCPR in January 1997 to identify central managed care research questions in the areas of health care markets, access, chronic illness, and long term care.
Topics: Chronic Conditions, Long-term Care, Managed Care, Markets, Research Agenda.
Availability: AHCPR Publication No. 98-R019 is available from the AHRQ Publications Clearinghouse.

Authors: Fraser I, Brach C.
Title: Meeting Medicaid's cost and quality challenges: The role of AHRQ research.
Publication: Rockville (MD): AHCPR.
Date: 1997
Abstract: This Program Note describes AHCPR's role in providing research and technical assistance to the Medicaid program in six areas: care for elderly and disabled populations, maternal and child health, HIV and AIDS, drug policy, informing consumers, and system financing and management.
Topics: Medicaid.
Availability: AHCPR Publication No. 97-0044 is available from the AHRQ Publications Clearinghouse. Select to access online version.

Authors: Meyer J, Rybowski L, Eichler R.
Title: Theory and reality of value-based purchasing: Lessons from the pioneers, edited by Fraser I.
Publication: Rockville (MD): AHCPR.
Date: 1997
Abstract: This article describes some of the most promising examples of private business initiatives that build quality considerations into health care purchasing decisions. The article profiles nine companies and coalitions, and summarizes their activities.
Topics: Purchasing.
Availability: AHCPR Publication No. 98-0004 is available from the AHRQ Publications Clearinghouse.

Authors: Gaus C, Fraser I.
Title: Shifting paradigms and the role of research.
Publication: Health Aff 15(2):235-42.
Date: 1996
Abstract: This article discusses the tasks of providing information as well as monitoring and evaluating the impact of change to be carried out by government and foundation researchers. It includes a discussion of a new integrated survey design that relates aspects of health care status, use, cost, and financing to type of service, source of care, and type of payment.
Topics: Methods, Research Agenda.
Availability: AHCPR Publication No. 96-R107 is available from the AHRQ Publications Clearinghouse.

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