Integrated Framework for Reducing Racial and Ethnic Disparities in the Quality of Health Care. Marshall H. Chin, MD, MPH, and Don Goldmann, MD University of Chicago, Institute for Healthcare Improvement. Roadmap.
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Marshall H. Chin, MD, MPH, and Don Goldmann, MD
University of Chicago, Institute for Healthcare Improvement
Context and problems in current efforts to reduce disparities in health care quality
Conceptual models for reducing disparities
Evidence on disparity interventions
6 key components for reducing disparities
Implications for funders
Exercise: Advice to AHRQ
Based on Berwick, Health Affairs 2002;21:n. 3
Resources and Policies
Organization of Health Care
Functional and Clinical Outcomes
Policy / Payment / Regulation / Accreditation
Reviewed 200+ articles
Multifactorial interventions that address multiple leverage points along a patient’s pathway of care
Culturally tailored QI more than generic QI
Nurse-led interventions with multidisciplinary teams and close tracking and monitoring of patients
Chin MH, et al. Med Care Res Rev 2007; 64:7S-28S.
Chin MH, et al. Pediatrics 2009;124 (Suppl 3):S224-S236.
1) Examine your performance data stratified by insurance status, race/ethnicity, language, and socioeconomic status.
Chin MH. Ann Intern Med 2008; 149:206-208.
Provide models of care and infrastructural support to enable organizations to improve the quality of care for vulnerable patients.
Align incentives to reward providers and health care organizations for providing high quality care to vulnerable populations.
Allocate more resources for the uninsured with chronic diseases.
Which spheres are you addressing or plan
to address in your comprehensive,
multifactorial approach to reducing an equity gap ?
Health care delivery organization
Community and region
Policy, payment, regulation, accreditation