While the poorer health status of minority populations can be attributed to social and economic factors and lack of access to medical care, there is more to the story than that. What is striking is what happens once minorities enter the health care system. Mounting evidence indicates that minority populations within the health care system experience poorer health outcomes--even after controlling for income, education, type of insurance, and severity of illness.
Ever since the Institute of Medicine published Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Smedley, Stith, and Nelson, 2002), it has remained the clearest and most comprehensive articulation of what was already apparent to many in health care: that health outcomes vary by race and ethnicity.
Unequal Treatment established unequivocally that disparities occur due to differential treatment within clinical settings of members of different races and ethnicities. In so doing, the report marked a turning point for the study of health care disparities. "The real challenge lies not in debating whether disparities exist because the evidence is overwhelming," said Alan Nelson, chair of the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Now the health care field needs to focus on "developing and implementing strategies to reduce and eliminate [disparities]."
The first step in this process is to pinpoint the factors that lead to different outcomes. Why do African American patients tend to receive less aggressive treatment for heart disease? Why do Hispanics tend to be subjected to less desirable procedures for conditions like diabetes? Is it a function of bias on the part of the physician, suspicion or lack of familiarity on the part of the patient, or communication barriers?
HRET has taken a lead role in our nation's effort to eliminate disparities in health care. With support from the Commonwealth Fund, HRET convened a consortium of six leading hospitals and health systems to take a leading role in addressing this serious issue. Working with this consortium and a National Advisory Panel, from 2001 to 2004, HRET developed a program called "Eliminating Disparities through Community and Hospital Partnerships" that has been a critical part of the effort to eliminate health disparities.
In order for hospitals, clinics, and other health care organizations to determine the nature and extent of disparities among their patient populations, accurate patient race, ethnicity, and primary language data are needed. Only with standardized and consistent patient data can quality measures be appropriately stratified to reveal the scope of disparities in treatment and outcomes.
In collaboration with Northwestern Memorial Hospital (NMH), HRET developed a framework for collecting race, ethnicity, and primary language data from patients and in 2004 launched the HRET Disparities Toolkit. NMH has successfully implemented the data collection framework. In addition, HRET has worked with a number of hospitals, health systems, and other organizations across the country to improve systematic data collection.
In 2007, HRET released the updated 2.0 edition of the Disparities Toolkit. In early 2009, the National Quality Forum endorsed the toolkit as a recommended quality improvement practice. In April and May of 2009, HRET conducted a brief survey of organizations that accessed and used the Disparities Toolkit to learn about current use of the Toolkit in the field and other resources health care providers may need to address possible disparities.
To access the Disparities Toolkit, go to www.hretdisparities.org.
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