Roadmap To Reduce Disparities In The Quality Of Care For Minority Patients Identified

By nearly every measure, healthcare for racial and ethnic minorities falls short of the quality received by white Americans, for whom it is widely acknowledged that quality is also far from optimal. In a report released today, a 22-member expert panel convened by the National Quality Forum (NQF) identifies 10 priority actions that should be taken to improve the quality of healthcare for minority patients. "Improving Healthcare Quality for Minority Patients" summarizes the proceedings of an NQF workshop sponsored by the Commonwealth Fund of New York. The expert panel concluded that undertaking a small number of specific steps holds the promise for significantly improving the healthcare quality provided to racial and ethnic minority populations. "A system for systematically measuring and reporting the quality of healthcare is needed for everyone in America, but special attention needs to be directed towards addressing the disparities in the quality of healthcare for minority patients," said Kenneth W. Kizer, MD, MPH, President and CEO of the NQF. "Healthcare quality in the United States must rise to both a higher and more equitable level than currently exists." "Developing quality of care data to document health care disparities is a priority of the Commonwealth Fund's program to improve quality of care for underserved populations," said Karen Scott Collins, MD, vice president at the Fund. "The NQF's leadership in developing this action plan is an important step towards eliminating racial and ethnic disparities in healthcare." "As we increase the collection of race/ethnicity and language data, we will be able to better monitor how health services are utilized and improve culturally competent and language services and quality to minority patients," said Elena Rios, MD, President of the National Hispanic Medical Association. Approximately one in three Americans belongs to a racial or ethnic minority group. Healthcare quality measurement and reporting strategies that do not address the health needs of minority patients neglect a significant and growing portion of the U.S. population. The consequences of this neglect are further exacerbated because minorities often shoulder a disproportionate share of poor healthcare quality even when they have access to the healthcare system. For example:

• African Americans with colorectal cancer are treated less aggressively than white Americans of similar socioeconomic levels.
• Hispanics, Asian American/Pacific Islanders, and African Americans receive specialty cardiovascular care compared to each other and to white Americans.
• Minority cancer patients were less likely to have access to beneficial pain management.
• Pneumonia and influenza are among the leading causes of deaths in minority patients, but African Americans, Hispanics, Asian Americans American Indian/Alaska Natives are vaccinated less often for these conditions than white Americans.

To address these and other healthcare quality disparities, the NQF experts recommend that providers, consumers, purchasers, researchers, policymakers and regulators take the following 10 priority actions:

1. Adopt the specific goal of eliminating disparities
2. Analyze existing healthcare quality measures to fully quantify the magnitude of minority healthcare disparities and refine the measure sets to reflect priorities for improving healthcare quality for minority patients
3. Develop new measures that focus on areas in which racial and ethnic minorities bear a disproportionate burden of disease or poor healthcare quality
4. Adopt and utilize a standardized set of cross-cutting quality measures (e.g., pain management, availability of support services, and cultural competency)
5. Establish healthcare quality standards around population-based goals
6. Increase and sustain federal support to improve services and research to improve healthcare quality for minority patients
7. Adopt federal policies that specifically promote standardized classification and collection of race and ethnicity data in healthcare settings
8. As has been done for the U.S. Census, build support and awareness among the public and providers on the importance of race and ethnicity data collection to improving healthcare quality for minority populations
9. Engage the many disparate consumer audiences in the drive to improve healthcare quality
10. Use community-based intermediaries to develop and disseminate healthcare quality information to minority consumers

"We have documented for years that disparities exist in healthcare access, healthcare quality, and health outcomes for minority patients," said Kizer. "What is needed now is increased resolve and commitment by all healthcare industry stakeholders - providers, purchasers, consumers, researchers - to implement the report's recommendations." Additional information about the report, NQF, and its more than 140 member organizations can be found at www.qualityforum.org. The NQF is a private, non-profit public benefit corporation created in 1999 in response to a Presidential commission to develop and implement a national strategy for healthcare quality measurement and reporting. Established as a unique public-private partnership, the NQF has broad participation from all sectors of the healthcare industry. The Commonwealth Fund is a private foundation supporting independent research on health and social issues. Additional information about the Commonwealth Fund's projects in quality of care and in minority health can be found at www.commonwealthfund.org. Workshop Experts Leo S. Morales, MD, PhD, MPH (Co-chair), University of California, Los Angeles Kenneth W. Kizer, MD, MPH (Co-chair), National Quality Forum, Washington, DC Ignatius Bau, JD, Asian and Pacific Islander American Health Forum, San Francisco, CA Christina Bethell, PhD, MBA, MPH, Foundation for Accountability, Portland, OR Dorothy Brown, DrPH, Morgan State University, Baltimore, MD Felicia L. Collins, MD, MPH, U.S. Health Resources and Services Administration, Rockville, MD Kathryn L. Coltin, MPH, Harvard Pilgrim Health Care, Wellsley, MA Tuei Doong, MA, U.S. Department of Health and Human Services, Rockville, MD Kevin Fiscella, MD. MPH, University of Rochester School of Medicine, Rochester, NY Dawn M. FitzGerald, MS, Mid-South Foundation for Medical Care, Memphis, TN Merilyn D. Francis, RN, MPP, American Association of Health Plans, Washington, DC Jennie R. Joe, PhD, MPH, University of Arizona, Tucson, AZ Susan C. Miller, PhD, MBA, Brown University, Providence, RI Christine Molnar, MSPH, Community Service Society of New York, NY David R. Nerenz, PhD, Michigan State University, Lansing, MI Elena Rios, MD, MSPH, National Hispanic Medical Association Judy Roy, Red Lake Tribal Council, Red Lake, MN Cary Sennett, MD, PhD, American College of Cardiology, Bethesda, MD Sharyn M. Sutton, Sutton Social Marketing, Washington, DC Fernando M. Trevino, PhD, MPH, University of North Texas Health Science Center, Fort Worth, TX Marina L. Weiss, PhD, March of Dimes, Washington, DC Alastair J.J. Wood, MD, Vanderbilt University School of Medicine, Nashville, TN