Efforts to improve the quality of care and change financial incentives through such things as accountable care organizations and medical homes are a good conduit for reducing health disparities—if explicitly included, said Chin, director of the program Finding Answers: Disparities Research for Change. Hoping that a general quality improvement program will reduce disparities would be a mistake, as health equity must be an integral component for disparities to be affected, he said.
Now could be a pivotal time to try to do that as the industry moves to new payment models that reward hospitals for providing better quality care. Hospitals likely are already working on quality improvement programs, so adding a disparities dimension should not be difficult, Chin said.
As a result of that belief, quality plays a big role in an outline for industry participants to reduce disparities that was created by the Finding Answers program, based at the University of Chicago. The report, “A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care,” was published last week in the Journal of General Internal Medicine.
The roadmap includes six steps toward reducing health disparities: recognize disparities and commit to reducing them; implement a basic quality improvement structure and process; make equity an integral component of quality improvement efforts; design the intervention or interventions; implement, evaluate and adjust any interventions; and take action to sustain them.
“We're helping to fill a current gap in the field,” Chin said. The road map is based on 33 research projects and 12 systematic literature reviews conducted by the program. Chin said the roadmap is more broad and complete than existing efforts, such as the Equity of Care campaign, which was launched about a year ago by the Association of American Medical Colleges, the American College of Healthcare Executives, the American Hospital Association, the Catholic Health Association and the National Association of Public Hospitals and Health Systems.
The Equity of Care campaign is focused on three important matters—data collection, cultural competency and governance—but if the industry does only those things as part of its disparities reduction effort, “that won't be enough,” Chin said. Such programs do, though, “create the climate where you can take action,” he said.
Officials for groups that started Equity of Care said the campaign has done just that. “We've created new energy in the space,” said Marc Nivet, chief diversity officer for the AAMC. “That, in and of itself, is success,” he said. The campaign has helped raise awareness by posting about 100 case studies on disparities reduction on its website and also is planning a series of webinars on ways to promote health equity at hospitals, medical schools or other healthcare facilities.
Nivet, like Chin, said government-encouraged quality and reimbursement efforts emanating from the Patient Protection and Affordable Care Act could encourage hospitals to step up their efforts to rid healthcare of disparities among minorities.
The ACA creates more of a financial case for reducing disparities given the government and private insurers' efforts to improve quality, officials said. “Initially, we approached it as a moral imperative, but now it's also a business imperative,” said John Bluford, president and CEO of Truman Medical Centers, Kansas City, Mo., and immediate past chairman of the American Hospital Association.