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Full Title: Strategies for Improving Minority Healthcare Quality
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Context: The healthcare system in the United States does not provide the same quality of care for ethnic minority populations that it does for the majority white population. Despite awareness of inequities in healthcare quality, little is known about strategies with the potential to improve the quality of healthcare for minority populations.
Objectives: We performed a systematic review of evidence concerning the effectiveness of interventions designed to improve the quality of healthcare in racial or ethnic minorities. Our report focused on evaluations of interventions targeted at healthcare providers or organizations, as provider and organizational factors contribute substantially to disparities and inequities in access to and quality of healthcare.
Data Sources: Electronic searches of MEDLINE®, the Cochrane Collaboration's CENTRAL Register of Controlled Trials, EMBASE, and three specialty databases were performed. Hand searching of key journals and references lists was also performed. Electronic searching was completed in February 2003 and hand searching was completed to June 15, 2003.
Study Selection: Articles included in this evidence synthesis were English-language reports of evaluations of interventions that addressed one of the specific research questions.
Data Extraction: Pairs of reviewers assessed the study quality and abstracted data for each eligible article. Data were entered into a relational database.
Data Synthesis: Ninety-one articles were identified. Twenty-seven articles evaluated strategies targeted at healthcare providers or organizations to improve minority healthcare quality. The majority of these studies targeted physicians and most addressed aspects of prevention.
Main Results: There is excellent evidence that tracking/reminder systems can improve quality of care, and fair evidence that multifaceted interventions, provider education interventions, and interventions that bypass the physician to offer screening services to racial/ethnic minority patients can improve quality of care. Sixty-four articles evaluated cultural competence training as a strategy to improve the quality of healthcare in minority populations. Curricula addressed specific or general concepts of culture and were primarily group discussions and lectures. The lack of consistency in intervention methods and measured outcomes limited the evidence synthesis. There is, however, excellent evidence for improvement in provider knowledge, good evidence for improvement in provider attitudes and skills, and good evidence for improvement in patient satisfaction.
Conclusions: There is some evidence that interventions to improve quality of healthcare for minorities, including cultural competence training, are effective. More research is needed on quality improvement interventions specifically designed to reduce disparities. For example, interventions should target conditions and healthcare processes for which disparities have been documented. Also needed is more research on cultural competence training that uses rigorous study designs, well-described interventions and measurable objectives that are linked to process and outcome variables. Valid, reliable, and objective measurement of cultural competence is needed. As the literature grows, this information needs continued systematic review, updated on a regular basis and disseminated to clinicians, other healthcare decision-makers, educators, and the medical and health services research community.
Strategies for Improving Minority Healthcare Quality
Evidence-based Practice Center: Johns Hopkins University
Topic Nominator: National Quality Forum
Current as of January 2004