Recent national reports released by the Institute of Medicine (IOM)⁽⁹⁾ and the Agency for Healthcare Research and Quality (AHRQ)⁽¹⁰⁾ make clear that health care disparities are pervasive. Moreover, Senator Ted Kennedy (D-Mass.) and Senator Bill Frist (R.-Tenn.) each introduced a health care disparities bill to address the problem. In the past, the Fund has supported seminal work to identify the race and ethnicity of patients and link this information to quality-of-care indicators. The first of these studies, conducted by David Nerenz of Michigan State University, identified disparities in care within managed care plans, which subsequently led to the development of quality improvement programs.

Nerenz is now replicating his earlier work by partnering with the Health Resources and Services Administration on a project involving six state Medicaid programs and 12 health plans. The plans are using data on patients' race/ethnicity to pinpoint disparities revealed by HEDIS quality indicators and then implementing quality improvement projects to reduce or eliminate these disparities. This system for identifying and addressing disparities evidently has broader appeal: the state of Michigan is now planning to adopt it as part of its regular contractual requirements for Medicaid managed care plans. Building on the work of David Nerenz, the Center for Health Care Strategies recently announced that it will be working with up to 12 Medicaid plans in a Best Clinical and Administrative Practices (BCAP) collaborative to "improve health care quality for racially and ethnically diverse populations in Medicaid managed care." This large-scale initiative to eliminate disparities for publicly insured individuals is being supported by the Fund and the Robert Wood Johnson Foundation.

The Fund understands the importance of ensuring the accuracy of racial and ethnic data, as well as setting standards for how those data should be collected in clinical settings, who should be collecting the data, and in which categories they should be collected. In 2004, Romana Hasnain-Wynia and colleagues at the Health Research and Educational Trust (HRET) completed a project to develop a uniform framework for collecting data on patient race, ethnicity, and primary language in six leading hospitals and health systems.⁽¹¹⁾ In the next phase of work, the researchers will work with private hospitals within the University Healthsystem Consortium to collect and analyze performance data, stratified by race, ethnicity, and primary language, on 10 hospital quality measures used by the Centers for Medicare and Medicaid Services (CMS). Meanwhile, George Washington University's Bruce Siegel, M.D., will head up an effort to assess the feasibility of using the CMS hospital quality indicators, also stratified by race and ethnicity, in major safety net hospitals that treat large numbers of minority patients.