Patient Safety and Quality

Community health center collaboratives improve care quality but have little impact on disparities

Recently enacted health care reform legislation increases funding for community health centers (CHCs), which will nearly double the number of patients seen by the centers over the next 5 years. CHCs already care for more than 15 million Americans, many of whom belong to groups receiving care of lower quality. In order to eliminate health disparities and improve quality of care in CHCs, the Health Resources and Services Administration developed Health Disparities Collaboratives (HDCs). These collaboratives improve overall quality of CHC care, but have little impact on care disparities at the centers, reveals a new study.

The researchers studied 44 CHCs participating in HDCs for asthma, diabetes, or hypertension as well as 20 "external control" CHCs to determine whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. Over the 1-year period of the quality improvement collaborative, overall quality of care significantly improved because of the collaboratives. The 6.5 percent Hispanic-white disparity in quality of asthma care was eliminated. However, there were no other improvements in racial/ethnic or insurance disparities for any other condition. Over 10,000 patients were included in the study: 3,887 with asthma, 2,904 with diabetes, and 3,362 with hypertension. The collaboratives studied bring CHCs together to learn and disseminate quality improvement techniques developed by the Institute for Healthcare Improvement.

The findings suggest that approaches specifically targeting racial/ethnic and insurance disparities should be included as part of broad quality improvement initiatives. This study was supported by the Agency for Healthcare Research and Quality (HS13653).

See "Impact of health disparities collaboratives on racial/ethnic and insurance disparities in U.S. community health centers," by Dr. Hicks, James O'Malley, Ph.D., Tracy A. Lieu, M.D., M.P.H., and others in the February 8, 2010, Archives of Internal Medicine 170(3), pp. 279-286.

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