U.S. study outlines efforts to boost equal care

The gap between the best possible health care and actual care remains large, and disparities in health care delivered to racial and ethnic minorities remain "pervasive," new government studies conclude.

But improvements are possible, and in some cases they are already under way, said two reports that the U.S. Agency for Healthcare Research and Quality published in February.

The National Healthcare Quality Report examined the effectiveness, safety, timeliness and "patient centeredness" of treatment that people receive for cancer, diabetes, heart disease and six other areas. The National Healthcare Disparities Report then compared how these quality measures stacked up among racial, ethnic and economic minority groups.

Both reports contained a mixture of good and bad news but maintained an optimistic tone by highlighting proven ways that physicians and others in health care have closed quality and disparity gaps.

For example, diabetes is one area being addressed. The quality report noted that there was a 34% decrease in the hospital admission rate for uncontrolled diabetes between 1994 and 2001. The disparities report, however, noted that blacks, Hispanics and American Indians were more likely to die from diabetes and its complications than whites in 2001. It also noted that these groups were less likely to receive the five recommended tests and services for diabetes: A1c and lipid management, eye and foot exams and influenza immunization.

In Michigan, the American Medical Association Foundation's Train-the-Trainer program on health literacy was part of a collaborative effort that sought to eliminate disparities by improving outreach to people who have the disease. Members of MPRO, Michigan's quality improvement organization, attended the educational program in October 2003 that was funded with grants from the AMA Foundation, Michigan State Medical Society and others.

The end result was that the rate of lipid profile testing among diabetic African-American senior citizens in Wayne County increased, narrowing by 60.1% the quality gap between blacks and whites getting this test.

"We educated our colleagues about health literacy and pointed out that, if patients don't get educated, you cannot improve their health care," said AMA Foundation Board President Krishna Sawhney, MD. "Our colleagues took this to heart, MPRO helped, and the result is quite obvious."

Dr. Sawhney, a vascular surgeon for the Detroit area's Henry Ford Health System, gave credit to local political leaders and health care organizations for the project's success.

"Good things are possible if there is teamwork," Dr. Sawhney said. "The AMA and AMA Foundation can only deliver the message, and that message has to be taken up by our colleagues."