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Addressing Health Care Disparities

Quality Improvement Efforts


David Nerenz, Ph.D., Director and Professor, Institute for Health Care Studies, Michigan State University, East Lansing, MI.

Merry Tantaros, R.N., M.A., CPHQ, Project Manager, Managed Care/Community-Based Quality Improvement, CMRI, San Francisco, CA.

Glenn Flores, M.D., Associate Professor, Academic General Pediatrics, Medical College of Wisconsin, Milwaukee, WI.

One of the important ways in which health care disparities can be addressed is to improve health care quality. Examples of quality improvement efforts that can be used by health plans, the State and Federal government, health systems, and providers include:

  • David Nerenz of Michigan State University discussed an ongoing demonstration project in which health plans contracting with State Medicaid programs are collecting data on race and ethnicity. The plans then use that information in combination with utilization data and quality measures to identify populations that receive a poorer quality of health care and to develop targeted quality improvement efforts.

  • States can encourage or require health plans contracting with their Medicaid, SCHIP, and State employees' health benefit programs to design and implement quality improvement initiatives targeted at reducing racial and ethnic health care disparities.

  • The Federal government contracts with 53 Quality Improvement Organizations (QIOs) to help improve the quality of care provided to Medicare beneficiaries. These organizations can be a valuable resource to States; a number of them work directly with States to assist with quality improvement within their Medicaid programs. All QIOs were required in 2003 to design and implement health care disparities-focused quality improvement projects with managed care organizations serving Medicare beneficiaries.

    Merry Tantaros of CMRI, the QIO in California, described projects to develop a cultural competency self-assessment tool for health plans.

  • While many health systems and providers purport to provide translation services for their patients, research indicates that the nature and quality of these translation services can have significant implications for the quality of care and health outcomes experienced by persons with limited English proficiency (LEPs).

    Dr. Glenn Flores from the Medical College of Wisconsin shared the results of his recent study, which found a greater incidence of translation errors made by informal and untrained interpreters compared to trained interpreters. Errors made by informal or untrained interpreters are more likely to result in clinical consequences. Dr. Flores and his colleagues recommended that States consider providing adequate reimbursement for the services of trained interpreters as part of their Medicaid and SCHIP programs.

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