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Past research supported by the Agency for Healthcare Research and Quality (AHRQ, formerly the Agency for Health Care Policy and Research) has helped to identify and explain the reasons for disparities in delivering health care to minority populations. This Program Brief summarizes how AHRQ's activities address three strategic goals as they apply to minority populations.
In recent years, research projects and other program activities of the Agency for Healthcare Research and Quality have addressed three strategic goals:
- Support improvements in health outcomes.
- Strengthen quality measurement and improvement.
- Identify strategies to improve access, foster appropriate use, and reduce unnecessary expenditures.
In accordance with its reauthorizing legislation, AHRQ will also establish a Priority Populations Office to ensure that the needs of these populations are addressed throughout the Agency's portfolio, including extramural and intramural research, data development, and training. This Office and other AHRQ initiatives will enhance the Agency's commitment to improving health and health care for minority populations.
AHRQ's current programs, projects, and activities that address these goals as they apply to minority populations are briefly summarized below.
Supporting Improvements in Health Outcomes
Research by AHRQ and others has shown that, when compared with the white population, racial and ethnic minority populations often experience different outcomes from health care. For example, one AHRQ-supported study found differences in outcomes, even after adjusting for socioeconomic status, between black and white patients treated for diabetes or asthma; furthermore, treatments that were successful in white patients were not always transferable to black patients. Past AHRQ research aimed at improving health outcomes among minority populations has included a focus on preventive care for minority women and preventing low birth weight.
Several currently funded grants address a range of outcomes-related issues:
- One project is attempting to determine whether race and gender influence the rate of performance of selected cardiac tests and procedures.
- A grant focusing on asthma care is studying the cost-effectiveness of clinical practice guidelines designed to reduce asthma morbidity in children. If effective, implementation of these interventions could have significant impact on the lives of an increasing number of children with asthma, many of whom are minority.
- Using hysterectomy as the reference procedure, another project is developing methods for risk adjustment for surgical procedures which are performed in otherwise healthy populations. Hysterectomy is performed at very high rates in black women, who also have higher complication rates compared with other women. The study will compare performance of different providers based on patient outcomes.
Strengthening Quality Measurement and Improvement
AHRQ-supported projects have enhanced the ability to measure quality in different minority populations. AHRQ's Consumer Assessment of Health Plans (CAHPS®) survey questionnaire has been translated into Spanish to assist Hispanic Americans with their selection of health plans. In another project, investigators translated into Chinese a health status instrument (SF-36) used to assess various dimensions of health and validated their translation. Another team of AHRQ-supported researchers developed an instrument for assessing the interpersonal processes of care from the perspective of minority patients.
Examples of grants funded in fiscal year (FY) 1999 that aim to improve quality measurement are listed below:
- One project is developing child health status instruments that comprehensively measure the health and illness profile of children ages 5 to 11. The instruments will facilitate evaluation of the effects of health care on children. The project's geographic location (Baltimore) will result in a project targeting minority children.
- Quality of care for Asian Americans is the aim of one study which will conduct separate focus groups for Chinese and Vietnamese patients to identify important patient issues, then develop and validate patient questionnaires. The primary products will be new ways to evaluate quality of care for Chinese and Vietnamese populations at risk because of language, cultural, and other barriers.
- Another project is developing and evaluating a quality improvement model for treating neonatal jaundice in certain managed care organizations (MCOs). This condition is particularly significant to minority populations; incidence of newborn jaundice in Hispanic, Asian, and Native American infants is 1.5 to 2 times that of white infants.
- Another project is comparing different support systems to help primary care providers better manage the care of urban African Americans with non-insulin dependent diabetes mellitus.
Identifying Strategies To Improve Access, Foster Appropriate Use, and Reduce Unnecessary Expenditures
Previous AHRQ research has documented differences in access, use, and cost of health care for minority populations compared with the general population. This work continues with ongoing analysis of survey data and a number of current research projects.
Medical Expenditure Panel Survey (MEPS)
MEPS is a nationally representative survey that collects detailed information on the health status, health services use and costs, and health insurance coverage of individuals and families in the United States, including nursing home residents. MEPS is ongoing and examination of data continues. Analyses of MEPS data published in 1999 showed that:
- Use of ambulatory care and dental care was lower among blacks and Hispanics than among other patients.
- Hispanics tend to spend less on health care compared with blacks and whites.
- Nonelderly Hispanic and African American adults are more likely than whites to report they are in fair or poor health (17 and 16 percent respectively for Hispanic and African American adults ages 18-64 compared with 10 percent of white adults).
AHRQ-supported grants funded in FY 1999 that address cost, use, and access issues include:
- An evaluation of how organizational and financial arrangements in Medicare managed care and fee-for-service settings affect the use and content of primary and referral care for patients with diabetes.
- A project comparing the text of brochures translated into Spanish with that of brochures originally written in Spanish that are distributed to Spanish-speaking adults in southern Arizona and northern Mexico. The project, which investigates whether Spanish-language health-related messages are reaching their targeted audience, aims also to make health professionals and institutions more aware of the written communication needs of minority patients.
- An investigation of cultural competence that will examine how the Massachusetts acute care hospital industry is undertaking structural and process improvements to ensure quality, access, and effectiveness of health care for racial/ethnic minority groups.
- A study of the effectiveness of interventions designed to increase appointment scheduling for breast and cervical cancer screening in low-income women ages 18-64 and to test the interaction of the interventions with ethnicity and race.
Addressing Disparities in Health Care
In fiscal year 1999, AHRQ expanded its support for minority health services research by setting aside funds for projects that addressed conditions identified in the President's Initiative to Eliminate Racial and Ethnic Disparities in Health. These projects resulted from a series of three published AHRQ initiatives, discussed below, that solicited the health services research community to develop new research, tools, and information designed to improve health care for priority populations. The initiatives were also designed to help build capacity in the field of health services research.
Measures of Quality of Care for Vulnerable Populations. This initiative seeks to develop and test new quality measures for use in the purchase or improvement of health care services for priority populations. Four research grants are now underway in this area:
- One project will develop a quality of care measure for hypertension in a population of Hmong refugees in Fresno, California, and conduct a pilot test of the instrument.
- A second project will evaluate the performance of census-based data as a proxy for socioeconomic indicators and determine the extent to which socioeconomic measures account for disparities in the quality of care provided to black and Hispanic patients.
- A third study will develop new methods to measure the quality of care for very low birthweight infants and apply a minimum set of measures that summarize quality differences.
- Investigators in a fourth project will use Medicaid data to develop claims-based quality measures for ambulatory diabetes care.
Assessment of Quality Improvement Strategies in Health Care. In 1999, AHRQ funded a study that will create a partnership with six health providers to evaluate the effectiveness of nurse management compared to "usual care" for congestive heart failure patients in east and cental Harlem. The project resulted from an AHRQ initiative to expand the conceptual and methodological bases for improving clinical quality and to analyze the relative utility and costs of various quality improvement approaches.
Translating Research Into Practice (TRIP). The initial TRIP solicitation aimed to generate new knowledge about approaches that effectively promote the use of rigorously derived evidence in clinical settings and lead to improved health care practice and sustained practitioner behavior change. Three studies are underway:
- One grant focuses on patients with diabetes who receive care at community health centers—critical sites of primary care for minorities and others who reside in medically underserved areas.
- A project to improve home health care nurses' performance and promote adherence to evidence-based guidelines will focus on two tracer conditions in which women and minority patients are overrepresented:
- Congestive heart failure.
- Cancer pain.
- Another grant proposes to standardize the current variability in surfactant administration practices for the prevention and treatment of neonatal respiratory distress syndrome in preterm infants.
AHRQ has continued its commitment to minority health services research in FY 2000 through two new grant solicitations. In late 1999, AHRQ published a second TRIP initiative. A major component of TRIP II is a focus on better understanding reasons for health care disparities and ways to eliminate them. One priority is to determine to what extent general strategies need to be modified to improve quality of care for minority populations.
The other AHRQ initiative, Understanding and Eliminating Minority Health Disparities, aims to support the development of "centers of excellence." The health services research conducted by these centers will provide information about which factors affect the quality, outcomes, cost, and access to health care for minority populations.
Building a Research Community
Future Research Directions
In May 1999, AHRQ convened an expert workshop, "Future Directions for Health Services Research Regarding Minority Populations." Clinicians, health services researchers, and community leaders met to discuss the Agency's future research agenda and identify appropriate priorities and questions for minority health services research as well as strategies for building a minority health services research community. Issues and suggestions included:
- Increasing research devoted to evaluating the importance of cultural competence to health care disparities.
- Facilitating involvement by minority communities in health services research.
- Incorporating research on minority health services and needs into other research efforts.
- Building capacity for health services research among minority institutions and minority investigators.
AHRQ is continuing to incorporate recommendations from this workshop into the Agency's ongoing programs.
General Career Development Opportunities
AHRQ is committed to increasing awareness of training opportunities in the field of health services research. The Agency has a range of short- and long-term career development opportunities open to undergraduate and postgraduate students and to new
investigators. Select for information on Research Training.
AHRQ continues to encourage increased participation in these programs by minority researchers and students.
More information on these career development opportunities and on predoctoral fellowships for minority students is available from:
Debbie Rothstein, Ph.D.
Office of Research Review, Education, and Policy
Phone: (301) 427-1525
In addition, AHRQ contributes to the support of two youth initiatives which encourage junior and senior high-school students to pursue health careers. AHRQ's participation emphasizes the importance of building the research pipeline by developing interest among students at the high school level.
AHRQ's contribution to these initiatives is an important component of a comprehensive strategy to increase the pool of students exposed to health services research and, ultimately, to increase the diversity of the health services research community.
Training Opportunities for Minority Students
AHRQ is committed to enhancing the racial and ethnic diversity within the health services research sciences and offers a number of training opportunities to minority students. These include:
- Research supplements to currently funded grants that enable the investigator to offer a training opportunity for a minority researcher or to expand the scope of the research into an area that addresses issues concerning minority populations.
- A summer program at Harvard Medical School for students from NIH-funded Minority Access to Research Careers (MARC) institutions that provides research training in health services or health policy research to students who otherwise might not have considered these career options.
- Predoctoral fellowships for minority students that provide up to 5 years of support for health services research training leading to the Ph.D. or equivalent research degree; the combined M.D./Ph.D. degree; or other combined professional or research doctoral degree.
AHRQ Publication No. 00-P040
Current as of February 2000