Political, financial, and organizational factors shaping local implementation and impact of national Health Disparities Collaborative strategies

The Health Disparities Collaborative (HDC) is a federally-promoted, locally-implemented initiative to improve systems of care in community health centers (CHCs). CHCs serve 16 million patients living in medically-underserved rural and urban areas. By improving the quality of care delivered to CHC patients, the HDC aims to reduce racial/ethnic disparities in health. This study will identify political, financial, and organizational factors shaping the local implementation and impact of national HDC strategies.

Approximately 800 CHCs have participated in the HDC since 1998. Published evaluations indicate the HDC improves quality of care delivered by some CHCs in the short-term. However, there is little research exploring why CHCs choose (or refuse) to participate in the HDC, how CHCs tailor national HDC strategies to suit local needs, and whether changes to CHC systems are sustainable. Using the case study method, I will analyze the implementation and impact of the HDC in four different CHCs. I will select cases purposively to include CHCs diverse in size, geographic location, and length of HDC participation. Sources will include in-depth interviews with CHC leaders and staff, document review, and participant observation at HDC training sessions, conferences, and CHCs.

Results of this study will include: 1) identification of strengths and weaknesses of HDC design and dissemination; 2) assessment of HDC impact to date and its potential to produce long-term improvements in quality and disparities; and 3) development of strategies to improve collaboration between the federal government and local public health entities responsible for policy and program implementation.