Using Quality Improvement to
Insure Equality in Healthcare
Quality
Why Quality Improvement?
• Equity is a core dimension of quality
• Avoids marginalization of disparity efforts.
Kevin Fiscella, MD, MPH
• Relies on evidence- based interventions.
University of Rochester School of Medicine & Dentistry
Departments of Family Medicine
Community & Preventive Medicine
Getting started
• Leverages existing resources
Assembling a QI/disparity team
• Racially/ethnically diverse team.
• Relevant areas of expertise
Choosing an area of focus
Sources of race/ethnicity data
• Local disparity data
• Hospital data and other
linked data sources
• Published literature
• Surveys such as CAHPS
• Impact on minority population health
• Geocoding/surname analysis
• Begin with areas ripe for success
• Collection of data on
admission/enrollment
1
Data on Healthcare Quality
• Self-report
Intervening
• Claims data
• Chart review
Tracking, recall, and prompts
• Near elimination of racial disparities in
childhood immunizations in Rochester.
• Elimination of racial disparities in influenza
immunizations in many VA hospitals.
Chronic Disease Management
• The Diabetes Control and Complications
Trial eliminated socioeconomic disparities
in diabetic control with intensive teaching
and management.
Practice Guidelines
The Hypertension and Follow-up Program
reduced racial disparities in hypertension
control and mortality using a stepped care
approach and protocol driven management.
Patient Empowerment
Patient coaching has been shown to improve
diabetes and hypertension control among
poor and minority patients.
• Has been shown to reduce racial disparities
in depression treatment and outcomes.
2
Provider blinding
• May be useful when the intervention
involves costly or limited resources and
where there is considerable discretion in
allocation.
Assess Impact of Intervention
• Modify approach/restudy problem
• Move on to next priority area
• Blinded review of cases at the Cleveland
VA eliminated racial disparity in coronary
artery revascularization.
Conclusion
Organizational QI is vital to eliminating
disparities in healthcare.
Many of the steps and approaches can be
adopted from conventional QI.
3