Recognizing that quality improvement programs targeting disparities need to be conducted in settings where underserved patients receive their care, the Bureau of Primary Health Care initiated the Health Disparities Collaboratives in 1998 to address disparities in care delivered to poor, minority, and other underserved populations in community health centers. The Fund is now cosponsoring, with AHRQ, a study of the Health Disparities Collaboratives on the quality of care for patients with hypertension, diabetes, and asthma. The results will determine whether the collaboratives have been effective in reducing care disparities for these patients. In another project supported by the Fund and AHRQ, investigators will examine the widespread underuse of effective medical services in New York City's East Harlem neighborhood and will test interventions to improve treatment for breast cancer, recurrent stroke, hypertension, and premature birth.

Patients who have limited proficiency in English or difficulty comprehending physician instructions and health information also experience difficulties accessing care. Many also receive lower-quality care or underutilize appropriate health services.^{(12),(13),(14),(15)} For a project focused on the needs of diabetes patients with limited English proficiency and low health literacy, Dean Schillinger, M.D., and colleagues at the University of California, San Francisco (UCSF), are implementing and comparing two types of patient self-management support—automated telephone-based management and group medical visits. In its 2004 Report on Health Literacy, the IOM featured the UCSF project as a promising model for addressing health literacy; the study is also highlighted in a new American Medical Association (AMA) textbook on the subject.⁽¹⁶⁾

In this past year, the Fund's Quality of Care for Underserved Populations Program announced a call for research proposals related to communication and quality of care for vulnerable patients. The strong interest in this field is evident in the more than 500 proposals received in response. After careful review, the program selected five projects, among them efforts to establish national standards of practice for interpreters in health care, understand adverse medical events for minority patients with limited English proficiency, and improve language services in small physician practices and health care benefit offices. The projects, which will be completed in the coming year, are expected to help raise awareness of the challenges faced by these patients and, more importantly, point to potential solutions.

Being able to communicate in a patient's primary language is an important component of health care providers' "cultural competency," but there is more to it than that. Cultural competency really involves responsiveness to all aspects of a patient's culture, enabling providers to promote greater engagement of patients in managing their medical conditions. However, in a Fund-supported survey of medical residents, Joel Weissman and colleagues at Harvard University found that medical residents reported a lack of confidence in being able to address many aspects of culturally competent care.⁽¹⁷⁾