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Published in: Journal of General Internal Medicine 8/2012

Open Access 01-08-2012 | Special Symposium: Interventions to Reduce Racial and Ethnic Disparities in Health Care

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

Authors: Marshall H. Chin, MD, MPH, Amanda R. Clarke, MPH, Robert S. Nocon, MHS, Alicia A. Casey, MPH, Anna P. Goddu, MSc, Nicole M. Keesecker, MA, Scott C. Cook, PhD

Published in: Journal of General Internal Medicine | Issue 8/2012

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Abstract

Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients’ needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient’s pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.
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Literature
1.
go back to reference Schlotthauer AE, Badler A, Cook SC, Perez DJ, Chin MH. Evaluating interventions to reduce health care disparities: an RWJF program. Health Aff. 2008;27:568–73.CrossRef Schlotthauer AE, Badler A, Cook SC, Perez DJ, Chin MH. Evaluating interventions to reduce health care disparities: an RWJF program. Health Aff. 2008;27:568–73.CrossRef
2.
go back to reference Glick SB, Clarke AR, Blanchard A, Whitaker AK. Cervical cancer screening, diagnosis, and treatment interventions for racial and ethnic minorities: a systematic review. J Gen Intern Med. doi:10.1007/s11606-012-2052-2. Glick SB, Clarke AR, Blanchard A, Whitaker AK. Cervical cancer screening, diagnosis, and treatment interventions for racial and ethnic minorities: a systematic review. J Gen Intern Med. doi:10.​1007/​s11606-012-2052-2.
3.
go back to reference Hemmige V, McFadden R, Cook S, Tang H, Schneider J. HIV prevention interventions to reduce racial disparities in the United States: a systematic review. J Gen Intern Med. doi:10.1007/s11606-012-2036-2. Hemmige V, McFadden R, Cook S, Tang H, Schneider J. HIV prevention interventions to reduce racial disparities in the United States: a systematic review. J Gen Intern Med. doi:10.​1007/​s11606-012-2036-2.
4.
go back to reference Naylor K, Ward J, Polite BN. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J Gen Intern Med. doi:10.1007/s11606-012-2044-2. Naylor K, Ward J, Polite BN. Interventions to improve care related to colorectal cancer among racial and ethnic minorities: a systematic review. J Gen Intern Med. doi:10.​1007/​s11606-012-2044-2.
5.
go back to reference Press VG, Pappalardo AA, Conwell WD, Pincavage AT, Prochaska MH, Arora VM. Interventions to improve outcomes for minority adults with asthma: a systematic review. J Gen Intern Med. doi:10.1007/s11606-012-2058-9. Press VG, Pappalardo AA, Conwell WD, Pincavage AT, Prochaska MH, Arora VM. Interventions to improve outcomes for minority adults with asthma: a systematic review. J Gen Intern Med. doi:10.​1007/​s11606-012-2058-9.
6.
go back to reference Saleha S, Kotwal AA, Dale W. Interventions to improve decision making and reduce racial and ethnic disparities in the management of prostate cancer: a systematic review. J Gen Intern Med. doi:10.1007/s11606-012-2086-5. Saleha S, Kotwal AA, Dale W. Interventions to improve decision making and reduce racial and ethnic disparities in the management of prostate cancer: a systematic review. J Gen Intern Med. doi:10.​1007/​s11606-012-2086-5.
7.
go back to reference Painter MW, Lavizzo-Mourey R. Aligning Forces for Quality: a program to improve health and health care in communities across the United States. Health Aff (Millwood). 2008;27:1461–3.CrossRef Painter MW, Lavizzo-Mourey R. Aligning Forces for Quality: a program to improve health and health care in communities across the United States. Health Aff (Millwood). 2008;27:1461–3.CrossRef
8.
go back to reference Chin MH, Goldmann D. Meaningful disparities reduction through research and translation programs. JAMA. 2011;305:404–5.PubMedCrossRef Chin MH, Goldmann D. Meaningful disparities reduction through research and translation programs. JAMA. 2011;305:404–5.PubMedCrossRef
9.
go back to reference Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S–28S.PubMedCrossRef Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007;64:7S–28S.PubMedCrossRef
10.
go back to reference Chin MH. Improving care and outcomes of the uninsured with chronic disease…Now. Ann Intern Med. 2008;149:206–8.PubMed Chin MH. Improving care and outcomes of the uninsured with chronic disease…Now. Ann Intern Med. 2008;149:206–8.PubMed
11.
go back to reference Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64:29S–100S.PubMedCrossRef Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64:29S–100S.PubMedCrossRef
12.
go back to reference Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64:101S–56S.PubMedCrossRef Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64:101S–56S.PubMedCrossRef
13.
go back to reference Van Voorhees BW, Walters AE, Prochaska M, Quinn MT. Reducing health disparities in depressive disorders outcomes between non-Hispanic whites and ethnic minorities: a call for pragmatic strategies over the life course. Med Care Res Rev. 2007;64:157S–94S.PubMedCrossRef Van Voorhees BW, Walters AE, Prochaska M, Quinn MT. Reducing health disparities in depressive disorders outcomes between non-Hispanic whites and ethnic minorities: a call for pragmatic strategies over the life course. Med Care Res Rev. 2007;64:157S–94S.PubMedCrossRef
14.
go back to reference Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev. 2007;64:195S–242S.PubMedCrossRef Masi CM, Blackman DJ, Peek ME. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev. 2007;64:195S–242S.PubMedCrossRef
15.
go back to reference Fisher T, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions using culture to reduce racial disparities in health care. Med Care Res Rev. 2007;64:243S–82S.PubMedCrossRef Fisher T, Burnet DL, Huang ES, Chin MH, Cagney KA. Cultural leverage: interventions using culture to reduce racial disparities in health care. Med Care Res Rev. 2007;64:243S–82S.PubMedCrossRef
16.
go back to reference Chien AT, Chin MH, Davis A, Casalino L. Pay-for-performance, public reporting and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007;64:283S–304S.PubMedCrossRef Chien AT, Chin MH, Davis A, Casalino L. Pay-for-performance, public reporting and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007;64:283S–304S.PubMedCrossRef
17.
go back to reference Chin MH, Alexander-Young M, Burnet D. Health care quality improvement approaches to reducing child health disparities. Pediatrics. 2009;124(Suppl 3):S224–36.PubMedCrossRef Chin MH, Alexander-Young M, Burnet D. Health care quality improvement approaches to reducing child health disparities. Pediatrics. 2009;124(Suppl 3):S224–36.PubMedCrossRef
20.
go back to reference Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010. Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act of 2010.
21.
go back to reference Institute of Medicine. Race, ethnicity, and language data: standardization for health care quality improvement. Washington, D.C.: The National Academies Press; 2009. Institute of Medicine. Race, ethnicity, and language data: standardization for health care quality improvement. Washington, D.C.: The National Academies Press; 2009.
22.
23.
go back to reference Sequist TD, Fitzmaurice GM, Marshall R, Shaykevich S, Marston A, Safran DG, Ayanian JZ. Cultural competency training and performance reports to improve diabetes care for black patients: a cluster randomized, controlled trial. Ann Intern Med. 2010;152(1):40–6.PubMed Sequist TD, Fitzmaurice GM, Marshall R, Shaykevich S, Marston A, Safran DG, Ayanian JZ. Cultural competency training and performance reports to improve diabetes care for black patients: a cluster randomized, controlled trial. Ann Intern Med. 2010;152(1):40–6.PubMed
24.
go back to reference Chin MH. Quality improvement implementation and disparities: the case of the Health Disparities Collaboratives. Med Care. 2010;48:688–75.CrossRef Chin MH. Quality improvement implementation and disparities: the case of the Health Disparities Collaboratives. Med Care. 2010;48:688–75.CrossRef
25.
go back to reference Integrating Chronic Care and Business Strategies in the Safety Net. (Prepared by Group Health’s MacColl Institute for Healthcare Innovation, in partnership with RAND and the California Health Care Safety Net Institute, under Contract No./Assignment No: HHSA2902006000171). AHRQ Publication No. 08-0104-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2008. Integrating Chronic Care and Business Strategies in the Safety Net. (Prepared by Group Health’s MacColl Institute for Healthcare Innovation, in partnership with RAND and the California Health Care Safety Net Institute, under Contract No./Assignment No: HHSA2902006000171). AHRQ Publication No. 08-0104-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2008.
26.
go back to reference Chin MH, Chien AT. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006;15:79–80.PubMedCrossRef Chin MH, Chien AT. Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship. Qual Saf Health Care. 2006;15:79–80.PubMedCrossRef
27.
go back to reference Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Healthcare System for the 21st Century. Washington, D.C.: National Academies Press; 2001. Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Healthcare System for the 21st Century. Washington, D.C.: National Academies Press; 2001.
28.
go back to reference Ulmer C, Bruno M, Burke S, eds. Future Directions for the National Healthcare Quality and Disparities Reports. Washington, D.C.: National Academies Press; 2010. Ulmer C, Bruno M, Burke S, eds. Future Directions for the National Healthcare Quality and Disparities Reports. Washington, D.C.: National Academies Press; 2010.
29.
go back to reference Yancy CW, Wang TY, Ventura HO, Piña IL, Vijayaraghavan K, Ferdinand KC, Hall LL. CREDO Advisory Group. The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists. J Am Coll Cardiol. 2011;57:245–52.PubMedCrossRef Yancy CW, Wang TY, Ventura HO, Piña IL, Vijayaraghavan K, Ferdinand KC, Hall LL. CREDO Advisory Group. The coalition to reduce racial and ethnic disparities in cardiovascular disease outcomes (credo): why credo matters to cardiologists. J Am Coll Cardiol. 2011;57:245–52.PubMedCrossRef
30.
go back to reference The Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: a Roadmap for Hospitals. Oak Brook Terrace, IL: The Joint Commission; 2010. The Joint Commission. Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: a Roadmap for Hospitals. Oak Brook Terrace, IL: The Joint Commission; 2010.
31.
go back to reference Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S, for the SQUIRE Development Group. Publication guidelines for improvement studies in health care: evolution of the SQUIRE Project. Qual Saf Health Care. 2008;17(Suppl 1):i3–9.PubMedCrossRef Davidoff F, Batalden P, Stevens D, Ogrinc G, Mooney S, for the SQUIRE Development Group. Publication guidelines for improvement studies in health care: evolution of the SQUIRE Project. Qual Saf Health Care. 2008;17(Suppl 1):i3–9.PubMedCrossRef
32.
go back to reference Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedCrossRef Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50.PubMedCrossRef
33.
go back to reference Huang ES, Zhang Q, Brown SES, Drum M, Meltzer DO, Chin MH. The cost-effectiveness of improving diabetes care in U.S. federally-qualified community health centers. Health Serv Res. 2007;42(6 Pt 1):2174–93.PubMedCrossRef Huang ES, Zhang Q, Brown SES, Drum M, Meltzer DO, Chin MH. The cost-effectiveness of improving diabetes care in U.S. federally-qualified community health centers. Health Serv Res. 2007;42(6 Pt 1):2174–93.PubMedCrossRef
34.
go back to reference Huang ES, Brown SES, Zhang JX, Kirchhoff AC, Schaefer CT, Casalino LP, Chin MH. The cost consequences of improving diabetes care: the community health center experience. Jt Comm J Qual Safety. 2008;34:138–146. Huang ES, Brown SES, Zhang JX, Kirchhoff AC, Schaefer CT, Casalino LP, Chin MH. The cost consequences of improving diabetes care: the community health center experience. Jt Comm J Qual Safety. 2008;34:138–146.
35.
go back to reference Beal A. High-quality health care: the essential route to eliminating disparities and achieving health equity. Health Aff. 2011;30:1868–71.CrossRef Beal A. High-quality health care: the essential route to eliminating disparities and achieving health equity. Health Aff. 2011;30:1868–71.CrossRef
41.
go back to reference Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report – United States, 2011. Morbidity and Mortality Weekly Report 2011; 60 Suppl:1–113. Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report – United States, 2011. Morbidity and Mortality Weekly Report 2011; 60 Suppl:1–113.
43.
go back to reference Fisher ES, McClellan MB, Safran DG. Building the path to accountable care. N Engl J Med. 2011;365:2445–7.PubMedCrossRef Fisher ES, McClellan MB, Safran DG. Building the path to accountable care. N Engl J Med. 2011;365:2445–7.PubMedCrossRef
44.
go back to reference Birnberg JM, Drum ML, Huang ES, Casalino LP, Lewis S, Vable AM, Tang H, Quinn MT, Burnet DL, Summerfelt T, Chin MH. Development of a Safety Net Medical Home Scale in Health Centers. J Gen Intern Med. 2011;26:1418–25.PubMedCrossRef Birnberg JM, Drum ML, Huang ES, Casalino LP, Lewis S, Vable AM, Tang H, Quinn MT, Burnet DL, Summerfelt T, Chin MH. Development of a Safety Net Medical Home Scale in Health Centers. J Gen Intern Med. 2011;26:1418–25.PubMedCrossRef
45.
go back to reference Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care–toward bundled Medicare payments. N Engl J Med. 2008;359:3–5.PubMedCrossRef Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care–toward bundled Medicare payments. N Engl J Med. 2008;359:3–5.PubMedCrossRef
46.
go back to reference Peek ME, Wilkes AE, Roberson T, Goddu A, Nocon R, Tang H, Quinn M, Bordenave K, Huang ES, Chin MH. Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Aff. 2012;31:177–86.CrossRef Peek ME, Wilkes AE, Roberson T, Goddu A, Nocon R, Tang H, Quinn M, Bordenave K, Huang ES, Chin MH. Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Aff. 2012;31:177–86.CrossRef
Metadata
Title
A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care
Authors
Marshall H. Chin, MD, MPH
Amanda R. Clarke, MPH
Robert S. Nocon, MHS
Alicia A. Casey, MPH
Anna P. Goddu, MSc
Nicole M. Keesecker, MA
Scott C. Cook, PhD
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 8/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-012-2082-9

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