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Strategies for Improving Minority Healthcare Quality
Evidence Reports/Technology Assessments, No. 90
Investigators: Mary Catherine Beach, MD, MPH, Lisa A Cooper, MD, MPH, Karen A Robinson, MSc, Eboni G Price, MD, Tiffany L Gary, PhD, Mollie W Jenckes, MHS, RN, Aysegul Gozu, MD, Carole Smarth, MD, Ana Palacio, MD, Carolyn J Feuerstein, BA, Eric B Bass, MD, MPH, and Neil R Powe, MD, MPH, MBA.
Structured Abstract
Context:
The healthcare system in the United States does not provide the same quality of care for ethnic minority populations that it does for the majority white population. Despite awareness of inequities in healthcare quality, little is known about strategies with the potential to improve the quality of healthcare for minority populations.
Objectives:
We performed a systematic review of evidence concerning the effectiveness of interventions designed to improve the quality of healthcare in racial or ethnic minorities. Our report focused on evaluations of interventions targeted at healthcare providers or organizations, as provider and organizational factors contribute substantially to disparities and inequities in access to and quality of healthcare.
Data Sources:
Electronic searches of MEDLINE®, the Cochrane Collaboration's CENTRAL Register of Controlled Trials, EMBASE, and three specialty databases were performed. Hand searching of key journals and references lists was also performed. Electronic searching was completed in February 2003 and hand searching was completed to June 15, 2003.
Study Selection:
Articles included in this evidence synthesis were English-language reports of evaluations of interventions that addressed one of the specific research questions.
Data Extraction:
Pairs of reviewers assessed the study quality and abstracted data for each eligible article. Data were entered into a relational database.
Data Synthesis:
Ninety-one articles were identified. Twenty-seven articles evaluated strategies targeted at healthcare providers or organizations to improve minority healthcare quality. The majority of these studies targeted physicians and most addressed aspects of prevention. There is excellent evidence that tracking/reminder systems can improve quality of care, and fair evidence that multifaceted interventions, provider education interventions, and interventions that bypass the physician to offer screening services to racial/ethnic minority patients can improve quality of care. Sixty-four articles evaluated cultural competence training as a strategy to improve the quality of healthcare in minority populations. Curricula addressed specific or general concepts of culture and were primarily group discussions and lectures. The lack of consistency in intervention methods and measured outcomes limited the evidence synthesis. There is, however, excellent evidence for improvement in provider knowledge, good evidence for improvement in provider attitudes and skills, and good evidence for improvement in patient satisfaction.
Conclusions:
There is some evidence that interventions to improve quality of healthcare for minorities, including cultural competence training, are effective. More research is needed on quality improvement interventions specifically designed to reduce disparities. For example, interventions should target conditions and healthcare processes for which disparities have been documented. Also needed is more research on cultural competence training that uses rigorous study designs, well-described interventions and measurable objectives that are linked to process and outcome variables. Valid, reliable, and objective measurement of cultural competence is needed. As the literature grows, this information needs continued systematic review, updated on a regular basis and disseminated to clinicians, other healthcare decision-makers, educators, and the medical and health services research community.
Contents
- Preface
- Acknowledgments
- 1. Introduction
- 2. Methodology
- 3. Results
- 4. Discussion
- Summary Tables
- Appendix A: Search Strings and Priority Journals
- Appendix B: Abstraction Forms
- Appendix C: Evidence Tables
- Appendix D: Peer Reviewers
- References and Included Studies
- Listing of Excluded Articles
- Included Studies, Appendix C
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.1 Contract No. 290-02-0018. Prepared by: The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.
Suggested citation:
Beach MC, Cooper LA, Robinson KA, Price EG, Gary TL, Jenckes MW, Gozu A, Smarth C Palacio A, Feuerstein CJ, Bass EB, Powe NR. Strategies for Improving Minority Healthcare Quality. Evidence Report/Technology Assessment No. 90. (Prepared by the Johns Hopkins University Evidence-based Practice Center, Baltimore, MD.) AHRQ Publication No. 04-E008-02. Rockville, MD: Agency for Healthcare Research and Quality. January 2004.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
AHRQ is the lead Federal agency charged with supporting research designed to improve the quality of health care, reduce its cost, address patient safety and medical errors, and broaden access to essential services. AHRQ sponsors and conducts research that provides evidence-based information on health care outcomes; quality; and cost, use, and access. The information helps health care decisionmakers—patients and clinicians, health system leaders, and policymakers—make more informed decisions and improve the quality of health care services.
The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services of a particular drug, device, test, treatment, or other clinical service.
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