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Beach MC, Cooper LA, Robinson KA, et al. Strategies for Improving Minority Healthcare Quality. Rockville (MD): Agency for Healthcare Research and Quality (US); 2004 Jan. (Evidence Reports/Technology Assessments, No. 90.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Strategies for Improving Minority Healthcare Quality

Strategies for Improving Minority Healthcare Quality.

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1Introduction

In recent years, it has become clear that the healthcare system in the United States does not provide the same quality of care for minority populations that it does for the majority white population. Racial and ethnic disparities in access to and quality of healthcare have been extensively documented.1 The Institute of Medicine (IOM) report “Unequal Treatment” confirmed that racial and ethnic disparities in healthcare are not entirely explained by differences in access, clinical appropriateness, or patient preferences.2 There is also increasing evidence that provider behaviors and practice patterns contribute to disparities in care.3 Moreover, researchers assert that variations in healthcare organizational processes compromise quality and that healthcare disparities signal a potentially ripe area for quality improvement.4

Despite awareness of inequities in healthcare quality, little is known about strategies with the potential to improve the quality of healthcare for ethnic minority populations. For those interested in quality improvement, there is a need for an evaluation and synthesis of the strategies proved to be effective in bettering the quality of healthcare for minorities. Moreover, it is unknown whether strategies specifically designed to reduce disparities in healthcare between racial/ethnic minorities and whites have been implemented successfully. One empirical question is whether interventions incorporating quality improvement strategies with documented efficacy for the general population are sufficient to improve quality of care for minorities and reduce disparities, or whether interventions must be specifically targeted to ethnic minority populations in order to improve quality and achieve equity. It has been suggested that cultural competence on the part of healthcare providers and organizations may be one such targeted strategy,5 but with the exception of one recent systematic review of healthcare system interventions6 the effectiveness of cultural competence initiatives targeting healthcare providers has not been systematically evaluated.

The purpose of this report is to systematically review the evidence to determine the effectiveness of interventions designed to improve the quality of healthcare and/or to reduce disparities for racial/ethnic minorities. Our report focuses on evaluations of interventions aimed at healthcare providers or organizations, as recent work suggests provider and organizational factors contribute substantially to the inequities. We began broadly by examining any type of strategy aimed at improving the quality of care in a racial/ethnic minority population of patients, and then we looked specifically at strategies designed to advance the cultural competence of healthcare providers or organizations. This evidence report was requested by the National Quality Forum (NQF) to address recommended priority actions that were outlined in its report “Improving Healthcare Quality for Minority Patients.”7

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