, et al
Impact of health disparity collaborative on racial/ethnic and insurance disparities in U.S. community health centers
Arch Intern Med
; doi:

The Health Disparities Collaboratives (HDC) sponsored by the Health Resources and Services Administration (HRSA) used quality improvement techniques developed by the Institute for Healthcare Improvement to improve care for chronic illness in the over 600 nationally-based Community Health Centers (CHC). In this study, Harvard Medical School researchers evaluated whether these programs narrowed disparities in care in addition to improving overall quality of care.

The study examined racial, ethnic, and insurance differences in the quality of care for individuals with asthma, diabetes mellitus, and hypertension in 64 CHCs: 44 of these centers had participated in one of the HDCs (intervention centers) and 20 had not participated in the HDC. Each intervention center was compared with an internal control – an intervention center participating in a different collaborative (example: hypertensive participant whose data was being analyzed would be reviewed for diabetic quality indicators). The 20 nonparticipating CHCs served as external controls.

Disparities in care were defined as a difference in quality of care between white patients and members of racial and ethnic minority groups, and between those with commercial or Medicare insurance and no insurance. Ethnic or racial disparities in quality of care for all conditions (asthma, diabetes, and hypertension) were documented. Changes in disparities over time for intervention clinics were compared to internal and external controls.

Overall, the medical records of 10,153 patients with one of the three target conditions (3,887 asthmatics; 2,904 patients with diabetes; 3,362 patients with hypertension) in the experimental and control groups were analyzed. The population was approximately 60% female with a mean age of 46 years. For all conditions, white patients received significantly higher quality of care than black or Hispanic patients in external control clinics. For example, white patients in external control clinics received 67% of recommended hypertension care; Hispanic patients received 63% and black patients 62% of recommended care. In contrast, the only racial/ethnic disparity documented in intervention CHCs was for asthma care at baseline.

Significant disparities in care by insurance status were observed for diabetes and hypertension care in both intervention and control clinics (P<.004 for all). Uninsured individuals in participating clinics received 34% of recommended care compared to 39% for the insured group (P<.001).

The collaborative intervention had a variable effect upon narrowing disparities. Greater reductions in Hispanic/white disparities for diabetes care were noted in external control centers than in participating centers. No improvement in disparity of care based on insurance was noted for any of the three conditions compared to controls over time. For diabetes care, the Medicaid population experienced an increase in disparity of care in collaborating centers as compared to external controls (P<.01).

This study demonstrates that while HDCs have been shown to improve quality of...

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