he goal of The Commonwealth Fund's Program on Quality of Care for Underserved Populations is to improve the quality of health care delivered to low-income Americans and members of racial and ethnic minority groups, and to reduce racial and ethnic health disparities. The program builds on efforts to improve quality of care overall in the United States, focusing on health care settings that serve large numbers of low-income and minority patients. The strategies it pursues include:
Uncovering disparities in health care provider performance begins with accurate data—including patient race, ethnicity, and income level. For several years, Fund grantees have sought to show how hospitals and health plans can obtain and analyze data on quality of care stratified by race and ethnicity. Early on, there were some concerns about the legality of collecting such information; these are now recognized to be unfounded and have by now largely dissipated.(1)
Still, many parties remain uncertain of the best way to collect such information, knowing that patients may be uncomfortable disclosing their racial and ethnic backgrounds to their health care providers.
In a Fund-supported study published in March 2006, David W. Baker, M.D., and his colleagues at Northwestern Memorial Hospital in Chicago demonstrated that allowing patients to describe their racial or ethnic background in their own words can improve the accuracy of such data.(2)
In another Fund-supported study, Baker and colleagues found that indeed there are right and wrong ways to ask patients about their race and ethnicity.(3)
Fully 80 percent of the patients interviewed for the study agreed that hospitals and clinics should document the racial and ethnic makeup of their patient populations. Yet, the interviews revealed that blacks were more likely than whites to express concern that the information would be used to discriminate against patients. Such concerns, the researchers say, can be addressed by clearly explaining the reasons for gathering information and seeking patients' input about how best to do so.