Robert S. Nocon

A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.

Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients’ needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient’s pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

Association Between Patient-Centered Medical Home Rating and Operating Cost at Federally Funded Health Centers

CONTEXT Little is known about the cost associated with a health centers rating as a patient-centered medical home (PCMH). OBJECTIVE To determine whether PCMH rating is associated with operating cost among health centers funded by the US Health Resources and Services Administration. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of PCMH rating and operating cost in 2009. PCMH rating was assessed through surveys of health center administrators conducted by Harris Interactive of all 1009 Health Resources and Services Administration–funded community health centers. The survey provided scores from 0 (worst) to 100 (best) for total PCMH score and 6 subscales: access/communication, care management, external coordination, patient tracking, test/referral tracking, and quality improvement. Costs were obtained from the Uniform Data System reports submitted to the Health Resources and Services Administration. We used generalized linear models to determine the relationship between PCMH rating and operating cost. MAIN OUTCOME MEASURES Operating cost per physician full-time equivalent, operating cost per patient per month, and medical cost per visit. RESULTS Six hundred sixty-nine health centers (66%) were included in the study sample, with 340 excluded because of nonresponse or incomplete data. Mean total PCMH score was 60 (SD, 12; range, 21-90). For the average health center, a 10-point higher total PCMH score was associated with a

Thirty years of disparities intervention research: what are we doing to close racial and ethnic gaps in health care?

2.26 (4.6%) higher operating cost per patient per month (95% CI,

Early Lessons From An Initiative On Chicago’s South Side To Reduce Disparities In Diabetes Care And Outcomes

0.86-

Patient-centered Medical Home Capability and Clinical Performance in HRSA-supported Health Centers

4.12). Among PCMH subscales, a 10-point higher score for patient tracking was associated with higher operating cost per physician full-time equivalent (

Health Care Utilization and Receipt of Preventive Care for Patients Seen at Federally Funded Health Centers Compared to Other Sites of Primary Care

27,300; 95% CI,

Associations between Medical Home Characteristics and Support for Patient Activation in the Safety Net: Understanding Differences by Race, Ethnicity, and Health Status

3047-

Comparing the Cost of Caring for Medicare Beneficiaries in Federally Funded Health Centers to Other Care Settings

57,804) and higher operating cost per patient per month (

Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings

1.06; 95% CI,

How 3 Rural Safety Net Clinics Integrate Care for Patients: A Qualitative Case Study

0.29-