Finding Answers:
Disparities Research For Change
Jeroan J. Allison, MD, MS
Special Editor
June 5, 2007
Academy Health
Presentation Overview
• Summary of findings
• Additional relevant material
• Discussion questions
Change in Core Quality:
2006 AHRQ National Health Disparities Report
C
Effective Interventions
• Diabetes
– Organizational restructuring
– Expanding role of nurse in chronic disease
management context
• Incentives (P4P, public reporting)
– Effect on disparities remains an empiric question
– Potential for disparity reduction
– Potential exacerbation for careless implementation
• Community Interventions
– Enormous potential
– Barriers underestimated
Culturally Leveraged Interventions
• Domains
– Individual health behaviors
– Access to care
– Health-care environment
• Findings
– Significant promise
– Highly variable response
– Nescient field
Fisher T, Burnet D, Huang E, Chin M, Cagney K. Cultural Leverage: Interventions
Utilizing Culture to Narrow Racial Disparities in Health Care. Medical Care Research and
Review. In Press.
Culturally Leveraged Interventions:
Individual Health Behavior
These interventions showed
promise in improving health;
however, a limited number
actually assessed health outcomes
and when they did,
the demonstrated effect was not robust.
Culturally Leveraged Interventions:
Access to Care
As a group, access interventions were
creative in using culture
to improve the health care of people of color;
however they struggled
to show significant improvements.
Culturally Leveraged Interventions:
Health-care Environment
As a group, these interventions
were the most heterogeneous
in approach
and outcome assessment.
Residential Segregation:
Beyond Patient, Provider, and System Interventions
• Fundamental versus proximate cause of
health disparities
• Consequences
– Neighborhood safety
– Housing adequacy
– Health promoting infrastructure
– Education
– Income
Williams D, Collins C. Public Health Reports. 2001; 116(5): 404-416
Inattention to eliminating residential
segregation and/or the conditions
created by it may limit the utility of
well-intentioned efforts to reduce
racial disparities in health.
Williams D, Collins C. Public Health Reports. 2001; 116(5): 404-416
Take Home Messages
• Health disparities remain an important problem
• Complex interactions
–
–
–
–
Race/ethnicity
Socioeconomic position
Health care system
Environment
• Potentially effective interventions
– Spectrum illustrated by current review
– No easy formula
– Significant variation by condition and setting
Conceptual Model
Financing / Regulation / Accreditation / Quality Improvement
Community
Health Care Organization
Provider
Person
Access
Patient
Process
Outcomes
Chin M. Walters A, Cook S, Huang E. Interventions to Reduce Racial and Ethnic Disparities in Health
Care. Medical Care Research and Review. In Press.
Discussion Questions
• Is there a tension between improving
health for all versus specific population
segments?
• Have we been too enthusiastic about
certain approaches?
– Community interventions
– Culturally leveraged interventions?
Discussion Questions
• How may we improve the approach to
community health worker interventions,
given the recognized emerging barriers?
• How may pay-for-performance and public
reporting be best configured to decrease
health disparities?
Discussion Questions
• How well do we understand the basic
mechanism leading to disparities in health
outcomes?
• How will current intervention strategies
translate to patients with complex comorbidity?
Discussion Questions
• What areas/approaches will allow the most
return on investment for reducing
disparities? For funding agencies? For
policy makers?
• What efforts are needed to move beyond
the patient, provider, and system
interventions discussed today?
Extra Questions
• Is there a tension between developing
interventions at multiple levels, such as
community, patient, provider, and system?
• Why do culturally leveraged approaches
appear to work under some circumstances
and not others?