Lifting all Boats: Quality Improvement as a Means to Reducing Racial Health Disparities

The disparity in breast cancer mortality between Black and White women in Chicago has grown significantly over the past two decades, with the rate for Black women now over twice that of White women(1). Chicago's disparity is significantly higher than some other metropolitan areas such as New York City suggestive of local environment or health system deficit. Based on the hypothesis that a major contributor to the disparity is variation in the quality of care, the Chicago Breast Cancer Quality Consortium, funded by Susan G. Komen for the Cure, is engaged in quality improvement(QI) as a means to address this disparity. The process underway involves collaborating with healthcare institutions and sharing data (by race when possible) in order to identify potential quality gaps in care and motivate quality improvement projects. The Consortium takes a unique approach; while most QI projects are conducted within individual hospitals, the Consortium has created a city wide and standardized QI initiative across area institutions involved in breast care. For some hospitals, this is the first QI project conducted across their own sites. Several of the safety net hospitals do not have QI departments or their own Institutional Review Boards for such research. Major strengths of the Consortium include a steering committee comprised of professionals from diverse but relevant fields in breast cancer and quality improvement from all across Metropolitan Chicago and its new federal designation as the nation's first Patient Safety Organization dedicated exclusively to breast health. This designation provides legal protections for the data being shared. Currently, 55 of the 72 Metropolitan Chicago hospitals (76%) are voluntarily participating in the Consortium including academic hospitals and safety-net institutions. Aggregate data are being collected and submitted by each institution to the Consortium with respect to screening (e.g., cancer detection rate, proportion of cancers than are minimal and early stage) and treatment (e.g. rate of testing of tumor markers, and rate of appropriate treatment given stage at diagnosis and tumor markers). Initial results of the data will be presented to institutions at the first Consortium symposium this summer. Results of the analysis will help identify gaps in quality of care and the Consortium will assist institutions (particularly low resource institutions who serve poor populations) acquire the resources to implement QI interventions. This presentation will cover the process for building the Consortium, the results of the data analysis related to quality and outcomes from the Consortium symposium.