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LeRoi S. Hicks, MD, MPH; A. James O’Malley, PhD; Tracy A. Lieu, MD, MPH; Thomas Keegan, PhD; Barbara J. McNeil, MD, PhD; Edward Guadagnoli, PhD; Bruce E. Landon, MD, MBA

Arch Intern Med. 2010;170(3):279-286.

Background  The Health Resources and Services Administration Health Disparities Collaboratives (HDCs) were developed to improve care for chronic medical conditions in community health centers (CHCs).

Methods  We examined whether HDCs reduced disparities in quality by race/ethnicity or insurance status in CHCs nationally. We performed a controlled preintervention/postintervention study of 44 CHCs participating in HDCs for asthma, diabetes mellitus, or hypertension and 20 "external" control CHCs that had not participated. Each intervention center also served as an "internal" control for another condition. For each condition, we created an overall quality score, defined disparities in care as the differences in care between racial/ethnic groups and insurance groups, and examined changes in disparity through a series of hierarchical models using a 3-way interaction term among period, patient characteristics of interest, and treatment group.

Results  Overall, HDCs had little effect on disparities in composite measures for asthma, diabetes, and hypertension. For asthma care, collaborative centers had a baseline Hispanic-white disparity of 6.5%, which changed to a higher quality of recommended care for Hispanic patients over white patients by 0.8%, resulting in a significantly reduced Hispanic-white disparity compared with the change in disparity seen in external controls (P = .04). There were no other improvements in racial/ethnic or insurance disparities for any other conditions.

Conclusions  Although HDCs are known to improve quality of care in CHCs, they had minimal effect on racial/ethnic and insurance disparities. In addition to targeting improvement in overall quality, future initiatives should include activities aimed at disparity reduction as an outcome.

Author Affiliations: Department of Health Care Policy, Harvard Medical School (Drs Hicks, O’Malley, Lieu, Keegan, McNeil, Guadagnoli, and Landon); Division of General Internal Medicine and the Brigham and Women’s–Faulkner Hospitalist Program (Dr Hicks) and Department of Radiology (Dr McNeil), Brigham and Women's Hospital; Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School and Division of General Pediatrics, Children's Hospital (Dr Lieu); and Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Dr Landon), Boston, Massachusetts.

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