A roadmap for reducing racial and ethnic disparities in health care

Over the past decade, health care researchers have shifted their focus from documenting disparities to identifying solutions to close the gap in care. In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change (FA) to identify promising interventions to reduce disparities. Since its founding, FA has performed systematic reviews of over 400 published studies of disparities interventions, administered a national grant process to evaluate the most promising practices, and disseminated findings on a national and regional basis. Most recently, FA became a technical assistance provider for Aligning Forces for Quality, RWJF's flagship program to improve quality of care.

FA has learned a considerable amount through these efforts about what needs to occur for health care organizations to close the equity gap. Based on this experience, we introduce a roadmap for reducing racial and ethnic disparities in care, a dynamic process in which individual interventions are just one part. The roadmap summarizes the major steps organizations need to take to be most effective in disparities reduction. They are:

1)acknowledge existing disparities and understand root causes (collect data stratified by race, ethnicity, and language; raise staff and provider awareness; set a standard for patient-centered, culturally appropriate care); 2)form a basic quality improvement infrastructure (adopt a culture of quality improvement; implement an established model of change - e.g. PDSA); 3)make equity an integral component of quality improvement efforts (incorporate equity into organization values and priorities; identify champions of equity) 4)develop an action plan to address disparities (research evidence-based solutions; choose a strategy based on available resources, equity goals, and organizational culture); 5)implement disparities reduction program (prepare work plan and anticipate implementation challenges; gain staff and provider buy-in; incorporate flexibility and opportunities for feedback; review progress toward equity goals; 6)sustain programs that work (incorporate the intervention into routine operations; incentivize providers and staff to invest in the program's ongoing success; allocate adequate financial and staff resources)

For each of these steps, FA has developed practical tools for health care organizations working to reduce racial and ethnic disparities. These include a database of promising intervention strategies, program procedure manuals that outline step-by-step implementation processes, and tip sheets addressing practical concerns, such as cost and leadership buy-in. FA aims to disseminate these resources widely in an effort to improve every patient's quality of care.