11.2 📚 國考版（醫師國考 / PGY OSCE）

11.2.0.1 📌 一頁重點整理 (Cram Sheet)

11.2.0.1.1 🔥 高 yield 5 條
  1. IOM 2003 “Unequal Treatment” = disparities awareness 起點
  2. SDOH 5 領域 + 80/20 rule
  3. Implicit bias universal + Implicit Association Test (IAT)
  4. Black F maternal mortality 3-4× white
  5. Disparities ≠ pure access：即使 access 一樣 outcome 仍差
11.2.0.1.2 🔢 必背數字
  • IOM Unequal Treatment：2003
  • SDOH 5 領域：economic、education、healthcare、neighborhood、social
  • Black F maternal mortality vs White：3-4×
  • Black CV mortality vs White：+30-40%
  • Black men prostate CA mortality vs White：2×
  • Health outcome by SDOH + behavior：~80%

11.2.0.2 ⭐ 高 yield 摘要

11.2.0.2.1 SDOH 5 領域 (Healthy People 2030)
  1. Economic stability
  2. Education access + quality
  3. Healthcare access + quality
  4. Neighborhood + built environment
  5. Social + community context
11.2.0.2.2 Disparity Examples（必記）
  • CV：Black mortality +30-40%
  • Maternal：Black F 3-4×
  • Cancer：Black M prostate 2× mortality
  • COVID-19：Black/Hispanic/Native disproportionate
11.2.0.2.3 Implicit Bias
  • Unconscious associations
  • IAT (Implicit Association Test)
  • Universal（含 minority providers）
  • 影響：pain mgmt、referral、surgical recommendation
11.2.0.2.4 Solutions
  • Individual：implicit bias training、cultural humility、structured decision、interpreters
  • System：diverse workforce、stratified quality metrics、navigation programs
  • Policy：address SDOH、anti-discrimination
11.2.0.2.5 IOM 2003 主要 findings
  • Disparities exist across all clinical settings
  • 即使 controlled for insurance、income、severity → 仍存在
  • → healthcare system itself contributes

11.2.0.3 🎯 自我檢測

  1. Q: IOM Unequal Treatment 哪年？ A: 2003
  2. Q: Black F maternal mortality vs White？ A: 3-4× higher
  3. Q: SDOH 5 領域？ A: Economic、Education、Healthcare、Neighborhood、Social
  4. Q: Health outcome by SDOH + behavior 比例？ A: ~80%
  5. Q: 評估 implicit bias 工具？ A: IAT (Implicit Association Test)

11.2.0.4 📚 想深入請看

⚠️ AI 草稿，未經盧醫師驗證。