Trends in racial and ethnic disparities intervention research: 1979-2010

In previous work, we examined results from 11 published systematic reviews to identify disparities interventions that demonstrated success in multiple studies, across multiple health conditions. These promising practices included: culturally targeting interventions to meet patients' needs; employing multidisciplinary teams of care providers; delivering skills-based health education; navigating patients through the care process; engaging family and community members in care delivery; and targeting multiple leverage points along a patient's pathway of care. In the present study, we analyze 30 years of intervention research to identify trends in the disparities literature, particularly related to these promising practices. We analyzed 364 articles (1979–2010) from 11 systematic reviews of disparity intervention studies covering nine health conditions. We coded three dimensions, including the strategy (n=9) (e.g., providing reminders and feedback), the level (n=6) (e.g., provider), and the mode of delivery (n=19) (e.g., EMR). Two reviewers coded each article and discussed discrepancies to consensus, and a senior researcher coded a 10% sub-set of the sample to ensure reliability. We divided studies into roughly evenly sized groups by year (2002 and before vs. 2003 and after) and conducted chi squared tests to determine whether there is a statistically significant association between the period of study and the outcome of interest. Seventy percent of all studies intervened at the patient level, 20% targeted the provider, 37% the microsystem, or care team; 15% the organization; 31% the community; and 1% targeted policy-level change. Only 1% of studies examined interventions using financial incentives to improve minority outcomes (either provider pay-for-performance or patient incentives). Of the promising practices previously identified, there were statistically significant increases in disparities research involving skills-based health education (37% vs. 52%, p=.01) and interventions that engage family or community members of patients (9% vs. 16%, p=.03). Most disparities intervention research targets change among patients. Studies exploring policy-, community-, organization-, microsystem-, and provider-level changes are less common, presenting an opportunity for future research.