Program Brief
The health of Americans has improved over the past few decades, but not all Americans have benefited equally. Many ethnic and racial groups have not shared in the advances in health outcomes and health care. To understand the causes and factors of these inequalities, the Agency for Healthcare Research and Quality (AHRQ) has awarded grants to nine "Excellence Centers To
Eliminate Ethnic/Racial
Disparities" (EXCEED). Each center is investigating a different theme in an effort to identify and eliminate the causes of health disparities.
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Background
Ethnic and racial disparities in health
have been well documented in recent
decades across a broad range of medical
conditions and for a wide range of
ethnic and racial groups. These
differences have been noted in health
outcomes, such as quality of life and
mortality; processes, quality, and
appropriateness of care; and the
prevalence of certain conditions or
diseases.
Disparities persist despite
improvements in health for the Nation
as a whole. For example:
- Between 1987 and 1995, mortality
from ischemic heart disease
decreased 20 percent for the overall
population but only 13 percent for
blacks.
- In 1996, the infant mortality rate
was nearly 2½ times greater for
blacks than whites.
- Black Medicare beneficiaries in one
study received less intensive
treatment from providers for
selected procedures than whites,
after controlling for other factors.1
- Mortality in another study was
higher for black males than white
males treated for colorectal cancer
despite similar surgical,
chemotherapy, and radiation rates.2
- The incidence rate for cervical
cancer is more than five times as
high for Vietnamese women in the
United States as for white women
(47.3 vs. 8.7 cases per 100,000
women).
- The prevalence of diabetes in
Hispanics and American
Indians/Alaska Natives is
approximately double that in
whites.
Despite being well documented, these
insights have not led to significant
improvements in racial and ethnic
disparities overall, in part because the
causes of and factors contributing to
these inequalities are inadequately
understood.
Expanding the Knowledge Base
In an effort to increase understanding
of such factors, the Agency for
Healthcare Research and Quality
(AHRQ) in October 1999 published a
Request for Applications (RFA) which
aimed to expand the knowledge base
on disparities in several clinical
conditions—e.g., diabetes, infant
mortality, cancer screening and
management, and cardiovascular
disease—for which prior research had
shown a disproportionate effect on
racial and ethnic minorities. The RFA,
"Understanding and Eliminating
Minority Health Disparities," called for
Centers of Excellence that would
conduct research specifically focusing
on the underlying causes of these health
care inequities, particularly causes that
could be addressed through
improvements in health services
delivery and health systems.
In September 2000, AHRQ awarded
grants to nine Centers to conduct a
series of related studies. Now known as
"Excellence Centers To Eliminate
Ethnic/Racial Disparities" (EXCEED),
the grants bring together teams of both
new and experienced investigators in a
5-year effort to analyze underlying
causes and contributing factors for
racial and ethnic disparities in health
care and to identify and implement
strategies for reducing and eliminating
them. The Centers of Excellence
approach enables assembly of a critical
mass of investigators to address a group
of projects linked by a central theme,
such as communication or cultural
competency. In addition, the Centers
are able to train new investigators with
an interest in minority health services
research.
The EXCEED program joins a series of
AHRQ initiatives aimed at improving
the health and health care of priority
populations and eliminating racial and
ethnic disparities in health outcomes
and in health care access and service
delivery.
EXCEED Projects
The nine EXCEED projects listed
below are supported by AHRQ in
partnership with other agencies in the
Department of Health and Human Services, including:
- The National Center
on Minority Health and Health
Disparities.
- The National Cancer
Institute.
- The National Institute of General Medical Sciences.
- The
Health Resources and Services Administration.
Each project comprises
a group of four to seven studies
organized around a central theme.
Access and Quality of Care for
Vulnerable Black Populations.
Identifies and examines effective
interventions for chronically ill African-American
adults and low-income
children who primarily receive care
from community providers in inner-city
and rural areas. (Principal investigator:
Robert M. Mayberry, Morehouse
School of Medicine, Atlanta, GA.)
Health Disparities in Minority Adult
Americans. Examines the effects of
communication barriers and
interventions to improve cultural
competence on cancer screening and
management of hypertension among
minority elderly populations. (Principal
investigator: Edmund M. Ricci,
University of Pittsburgh, Pittsburgh,
PA.)
Improving the Delivery of Effective
Care to Minorities. Assesses reasons
for the underuse of effective
interventions for managing premature
birth, breast cancer, stroke, and
hypertension in ethnically diverse
Harlem communities and evaluates
ways to eliminate underuse. (Principal
investigator: Mark R. Chassin, Mount
Sinai School of Medicine, New York,
NY.)
Overcoming Racial Health
Disparities. Focuses on addressing
health disparities in cancer,
hypertension, and HIV disease among
African American adults, particularly in
rural settings; includes collaborative
research partnerships with two
historically black universities. (Principal
investigator: Timothy S. Carey,
University of North Carolina, Chapel
Hill, NC.)
Promoting Effective Communication
and Decision Making for Diverse
Populations. Assesses strategies to
enhance communication and
decisionmaking by ethnic/racial
minority populations, including
developing decision aids for use in
coronary disease and cancer screening.
(Principal investigator: A. Eugene
Washington, University of California,
San Francisco, CA.)
Racial and Ethnic Variation in
Medical Interactions. Assesses the
extent to which problems in doctor-patient
communication contribute to
racial and ethnic disparities in health
care use. Also aims to develop effective
strategies for disseminating information
and building research capacity.
(Principal investigator: Carol M.
Ashton, Baylor College of Medicine,
Houston, TX.)
UCLA/Drew/RAND Program To
Address Disparities in Health.
Identifies principal factors responsible
for ethnic/racial disparities and tests
randomized interventions to address
those factors for infant mortality, colon
cancer, diabetes, and ischemic heart
disease. (Principal investigator: Martin
F. Shapiro, University of California, Los
Angeles, CA.)
Understanding and Eliminating
Health Disparities in Blacks.
Examines strategies to address
disparities in health status between
African Americans and whites,
including those in rural areas, with
specific clinical conditions including
HIV disease, cardiovascular disease, and
cancer. Principal investigator: Barbara
Tilley, Medical University of South
Carolina, Charleston, SC.)
Understanding and Reducing Native
Elder Health Disparities. Investigates
issues relating to reducing health
inequities among elderly American
Indians/Alaska Natives, such as diabetes
care and increasing participation in
cancer screening and other clinical
preventive services. (Principal
investigator: Spero M. Manson,
University of Colorado Health Sciences
Center, Denver, CO.)
AHRQ expects that lessons learned
from understanding and eliminating
racial and ethnic disparities in health
and health care as well as the practical
tools and strategies to eliminate these
disparities would be generalizable
beyond the communities studied. By
focusing on attributes of the ethnic and
racial groups, the underlying etiologies
for the disparities, and components and
conditions of interventions to eliminate
the disparities, these projects should
produce findings that are widely
applicable for minority as well as
majority populations across the country.
Building Research Capacity
Building capacity for health services
research that seeks to reduce
racial/ethnic inequities entails
augmenting the research skills and
abilities of ethnically diverse researchers
and institutions and developing
sustainable and meaningful research
relationships with communities and
community organizations. One of the
goals of EXCEED is to foster such
capacity-building efforts.
Training. Although AHRQ's
EXCEED program focuses on
understanding and eliminating
inequalities in health outcomes and
care, it will also facilitate development
of greater capacity both for health
services research by minority individuals
and institutions and for health services
research that is focused on reducing
racial and ethnic inequities in health
care. Such a lack of capacity has been
highlighted by the Association of
American Medical Colleges.3 Toward
this aim, several EXCEED projects link
new researchers with more experienced
investigators through both formal and
informal mentoring and career
development opportunities.
Research partnerships. The EXCEED
program also aims to yield greater
capacity for the study of disparities by
encouraging the formation of new
research relationships as well as building
on existing partnerships between
researchers, professional organizations,
and community-based organizations
instrumental in helping to influence
change in local communities. The
Centers are involved in participatory
research efforts in which community
members are involved in all stages and
aspects of the studies. Several
EXCEED projects are being conducted
in collaboration with community health
centers and other health care
organizations serving ethnically diverse
populations. AHRQ expects that these
participatory research partnerships will
help lead to more effective
implementation of research findings
that address the social, cultural, and
economic conditions of the community.
References
1. Lee AJ, Gehlbach S, Homer DW,
Reti M, Baker CS. Medicare
treatment differences for blacks and
whites. Medical Care 1997;35:1173-89.
2. Dominitz JA, Samsa GP, Landsman
O, Provenzale D. Race, treatment,
and survival among colorectal
carcinoma patients in an equal-access
medical system. Cancer 1998;82:2312-20.
3. Association of American Medical
Colleges. Draft recommendations
from the AAMC meeting on
minority health services research,
July 1997.
For More Information
More information on AHRQ and its
programs and projects is available online at
the AHRQ Web site: Minority Health, Funding Opportunities Overview, Research Findings.
AHRQ Publication No. 01-P021
Current as of May 2001
Internet Citation:
Excellence Centers To Eliminate Ethnic/Racial
Disparities (EXCEED): Program Brief. AHRQ Publication No. 01-P021, May 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/exceed.htm