Health information technology-supported quality improvement initiative reduces some ambulatory care disparitiesQuality improvement initiatives supported by health information technology (IT) have reduced racial disparities in ambulatory care of some chronic conditions and preventive services. However, achieving equity in areas with persistent care disparities will require more targeted, patient-directed, and systems-oriented strategies, concludes a new study. A team of Northwestern University researchers assessed the rate of change in 17 ambulatory care quality measures following the introduction of a health IT-supported, quality-directed quality improvement initiative. The measures ranged from use of beta-blockers for patients with a history of heart attack, and screening or treatment for diabetic nephropathy among patients with diabetes, to pneumococcal immunization and colorectal cancer screening.
The researchers found that quality of care improved for 14 measures among white patients and 10 measures among black patients. Racial disparities narrowed for two measures: prescription of antiplatelet therapy for patients with coronary heart disease and colorectal cancer screening. The study was done over a 2-year period in an academic general internal medicine practice in Chicago and included 8,919 black and white patients who were eligible for at least one of the 17 measures. Quality improved for black and white patients for five of the eight process-of-care measures, four of five preventive care measures, but none of the four intermediate outcome measures. It is notable that two of the three measures for which disparities widened were intermediate measures of disease control: glycemic control and cholesterol control for patients with diabetes.
The quality improvement initiative included electronic point-of-care clinical reminders, decision support tools within the electronic health record to promote adherence to clinical guidelines, and regular provider feedback. The conditions covered included coronary heart disease, heart failure, hypertension, and diabetes. The researchers recommend that to achieve more substantial improvements in health care equity, additional strategies, such as tools to improve patient engagement, patient-physician communication, and access to care, as well as systems-oriented strategies to improve care delivery, are still needed. This study was supported, in part, by the Agency for Healthcare Research and Quality (HS17163, HS15647).
See "Changes in disparities following the implementation of a health information technology-supported quality improvement initiative" by Muriel Jean-Jacques, M.D., Stephen D. Persell, M.D., Jason A. Thompson, B.A., and others in the Journal of General Internal Medicine 27(1), pp. 71-77, 2011.
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