Reducing Disparities in Health Care Quality for Priority Populations: An Approach Focused on Improving Care in Under-resourced Settings Using Health IT and Other Quality Improvement Strategies

This project was to sponsor a meeting on health disparities and to produce a report out of that meeting. The meeting, "Reducing Disparities in Health Care Quality in Under-Resourced Settings Using Health Information Technology and Other Quality Improvement Strategies," was held October 22-23, 2009, in Rockville, Maryland. There was wide representation from Federal agencies, a State rural health agency, health services researchers with expertise in quality improvement and disparities reduction, patient advocates, provider organizations representing potentially underresourced health care delivery settings (URS), employer groups, and other organizations. For the purpose of the meeting, URS were considered to be settings that provide care for people who have insurance with low reimbursement rates or those who have no insurance. These settings therefore have little monitory resources to invest in needed capital investments or new employees.

The main objective of the project was to:

• Build a research and action agenda for reducing disparities in health care quality among priority populations.

As part of this effort, AHRQ commissioned five papers. An introductory paper focused on how URS could overcome health information technology (IT) implementation challenges and provided insight on how health IT might improve care and reduce disparities. The remaining four papers were case studies of large and persistent disparities in quality of care as identified by the Department of Health and Human Services and AHRQ's National Healthcare Disparities and Quality Reports.

The case studies addressed the reduction of differences between: 1) Black and White children in asthma hospitalization rates; 2) Black, Hispanic, and White diabetic adults in lower-extremity amputation hospitalizations; 3) Black, Hispanic, and White women in receiving early prenatal care; and 4) low-income and higher-income Asian and White children and adults in receiving good provider-patient or family communication. The case studies combined literature reviews and creative thinking to produce recommendations for a research and action agenda.

During the meeting, participants identified the following specific research needs: increasing patient empowerment using health IT; using tools that are already in place; more testing of electronic medical records in URS serving priority populations; examining technology development and policy; understanding what is needed for maintenance once the IT is in place; applying the business case; and exploring the role of disease registries.

Meeting participants also suggested the following as possible directions for AHRQ to pursue: focus funding opportunities on small, low-reimbursement practices, and other URS; consider whether the funding process can be accelerated so changes in health IT can converge with research efforts; study how to facilitate partnerships among URS, researchers, and evaluators, and health IT experts; provide guidance on study designs that are both rigorous and relevant; and create a task force to continue work on disparities, under-resourced settings, health IT, and quality improvement.