Key Disparities Research Questions
Marshall H. Chin, MD, MPH
Associate Professor of Medicine
University of Chicago
Director, RWJF Finding Answers: Disparities
Research for Change NPO
AcademyHealth June 26, 2006
Roadmap
Finding Answers
 Key Questions

Finding Answers

Finding Answers: Disparities Research for
Change seeks to improve the quality of
health care provided to patients from
racial and ethnic backgrounds likely to
experience disparities.
Goals

Finding Answers will:
– Grant funds to discover and evaluate practical
and replicable solutions designed to reduce
and eliminate racial and ethnic health care
disparities.
– Conduct systematic reviews regarding racial
and ethnic health care disparities
interventions.
– Disseminate results.
Grants
Cardiovascular disease, diabetes,
depression
 3 Call for Proposals over 4 years
 20-25 grants
 $5 million - $50K-$300K

Eligible Interventions
Patient – e.g. disease management
 Provider – e.g. cultural competency
 Organization – e.g. QI
 Community linkage – e.g. CHW
 Policy – e.g. P4P

Call for Proposals Cycles

Call for Proposals Cycle 1
– 178 Brief Proposals
– 36 Full Proposal Invites
– Grantees chosen October 2006

Call for Proposals Cycle 2
– Launch end of 2006
Call for Proposals Cycle 3 – late 2007
 www.solvingdisparities.org

Systematic Reviews:
3 Products
Supplement to Med Care Research Review
 Searchable database on website – CVD,
DM, Depression
 Policy briefs

Med Care Research Review
Intro
 CVD
 DM
 Depression
 Breast cancer
 Culture-specific
 P4P and public reporting
 Policy

Observations
Lots of general QI interventions
 Relatively few studying minority
populations
 Vanishingly few on disparity reduction
 Holes

Key Questions: Targeting

Mix of general QI vs. culture-specific
– Raise the tide of all vs. target
– All providers vs. predominant providers of
minority patients
– General QI techniques vs. culture-specific

Operationalizing culture-specific
– Patient-centered and cultural competency
– Physical and mental – e.g. stigma
Key Questions: Implementation
Inside black box of implementation
 Replicable - $, effort, practical tools
 Sustainable
 Multicomponent – prioritization and
resource allocation
 Unintended consequences

– Positive
– Negative
Key Questions: Cost

Cost issues – business and societal
– Aligning the incentives

Resource capacity, esp. for predominant
providers of minority patients
Key Questions:
Community and Policy

Leverage full strengths of both community
and health care system
– Public health and medical care
– Community-based participatory research

P4P, public reporting, financial incentives