Thirteen years ago, I co-authored an Institute of Medicine report documenting that racial and ethnic minority patients routinely receive lower-quality care than their white counterparts, regardless of income or insurance status.
While the report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” received a lot of attention in 2002, it is sadly still relevant today, given the persistence of the disparities it documents.
As the Agency for Healthcare Research and Quality recently pointed out, even though we're progressing on improving healthcare quality, we're not so hot on improving equity. That's not to say there haven't been efforts to narrow the divide. In 2010, the Affordable Care Act authors specifically included provisions to reduce healthcare disparities and increase coverage options for vulnerable populations. And at the Robert Wood Johnson Foundation, eliminating healthcare disparities is central to our vision of building a nationwide culture of health, where all Americans have the opportunity to live their healthiest life possible.
And we can point to real progress creating the resources and knowledge base to address disparities. Through programs such as Finding Answers: Disparities Research for Change—a decade-long effort funded by the foundation to seek and evaluate strategies for eliminating disparities—we now know what does and doesn't work.
Here's what doesn't work: You can't get a handle on the effectiveness of quality-improvement activities aimed at improving equity if you don't track care by patient race and ethnicity.
All too often, these initiatives are focused solely on improving overall health, and ignore the critical need to close the gap between white and minority patients.
Here's what works: linking quality and equity. It's important to note the connection between the two, because equal access can still result in unequal care. As Finding Answers has shown, equity is a cross-cutting component of quality. Over the past decade, participating clinics and hospitals have identified steps providers can take to link quality and equity, from collecting basic patient data to measure disparities to implementing culturally appropriate approaches to patient care. Finding Answers has included this and other information in its Roadmap to Reduce Disparities, an evidence-based framework that healthcare organizations, technical-assistance providers and policymakers can follow to address disparities.