Improving care for minorities: can quality improvement interventions improve care and outcomes for XXXX minorities? Results of a randomized, controlled trial.

@entity1 @entity308
OBJECTIVE: Ethnic minority @entity1 often receive poorer quality care and have worse outcomes than white @entity1 , yet practice-based approaches to reduce such disparities have not been identified. We determined whether practice-initiated quality improvement (QI) interventions for @entity308 primary care @entity1 improve care across ethnic groups and reduce outcome disparities. STUDY SETTING: The sample consists of 46 primary care practices in 6 U.S. managed care organizations; 181 clinicians; 398 Latinos, 93 African Americans, and 778 white @entity1 with probable @entity308 . STUDY DEIGN: Matched practices were randomized to usual care or one of two QI programs that trained local experts to educate clinicians; nurses to educate, assess, and follow-up with @entity1 ; and psychotherapists to conduct Cognitive Behavioral Therapy. @entity1 and physicians selected treatments. Interventions featured modest accommodations for minority @entity1 (e.g., translations, cultural training for clinicians). DATA EXTRACTION METHODS: Multilevel logistic regression analyses assessed intervention effects within and among ethnic groups. PRINCIPAL FINDINGS: At baseline, all ethnic groups Latino, African American, white) had low to moderate rates of appropriate care and the interventions significantly improved appropriate care at six months (by 8-20 percentage points) within each ethnic group, with no significant difference in response by ethnic group. The interventions significantly decreased the likelihood that Latinos and African Americans would report probable @entity308 at months 6 and 12; the white intervention sample did not differ from controls in reported probable @entity308 at either follow-up. While the intervention significantly improved the rate of employment for whites and not for minorities, precision was low for comparing intervention response on this outcome. It is important to note that minorities remained less likely to have appropriate care and more likely to be @entity308 than white @entity1 . CONCLUSIONS: Implementation of quality improvement interventions that have modest accommodations for minority @entity1 can improve quality of care for whites and underserved minorities alike, while minorities may be especially likely to benefit clinically. Further research needs to clarify whether employment benefits are limited to whites and if so, whether this represents a difference in opportunities. Quality improvement programs appear to improve quality of care without increasing disparities, and may offer an approach to reduce health disparities.
