title: Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding provider and organization interventions.
abstract: BACKGROUND
  Despite awareness of inequities in health care quality, little is known about strategies that could improve the quality of healthcare for ethnic minority populations. We conducted a systematic literature review and analysis to synthesize the findings of controlled studies evaluating interventions targeted at health care providers to improve health care quality or reduce disparities in care for racial/ethnic minorities.
  
  
  METHODS
  We performed electronic and hand searches from 1980 through June 2003 to identify randomized controlled trials or concurrent controlled trials. Reviewers abstracted data from studies to determine study characteristics, results, and quality. We graded the strength of the evidence as excellent, good, fair or poor using predetermined criteria. The main outcome measures were evidence of effectiveness and cost of strategies to improve health care quality or reduce disparities in care for racial/ethnic minorities.
  
  
  RESULTS
  Twenty-seven studies met criteria for review. Almost all (n = 26) took place in the primary care setting, and most (n = 19) focused on improving provision of preventive services. Only two studies were designed specifically to meet the needs of racial/ethnic minority patients. All 10 studies that used a provider reminder system for provision of standardized services (mostly preventive) reported favorable outcomes. The following quality improvement strategies demonstrated favorable results but were used in a small number of studies: bypassing the physician to offer preventive services directly to patients (2 of 2 studies favorable), provider education alone (2 of 2 studies favorable), use of a structured questionnaire to assess adolescent health behaviors (1 of 1 study favorable), and use of remote simultaneous translation (1 of 1 study favorable). Interventions employing more than one main strategy were used in 9 studies with inconsistent results. There were limited data on the costs of these strategies, as only one study reported cost data.
  
  
  CONCLUSIONS
  There are several promising strategies that may improve health care quality for racial/ethnic minorities, but a lack of studies specifically targeting disease areas and processes of care for which disparities have been previously documented. Further research and funding is needed to evaluate strategies designed to reduce disparities in health care quality for racial/ethnic minorities.
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA. mcbeach@jhmi.edu
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Beach
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Gary
authors.forename: Eboni G
authors.initials: EG
authors.lastname: Price
authors.forename: Karen
authors.initials: K
authors.lastname: Robinson
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: Ana
authors.initials: A
authors.lastname: Palacio
authors.forename: Carole
authors.initials: C
authors.lastname: Smarth
authors.forename: Mollie
authors.initials: M
authors.lastname: Jenckes
authors.forename: Carolyn
authors.initials: C
authors.lastname: Feuerstein
authors.forename: Eric B
authors.initials: EB
authors.lastname: Bass
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: D005006:Ethnicity; D019317:Evidence-Based Medicine; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D008913:Minority Groups; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000379:methods*; D044469:Racial Groups; D012959:Socioeconomic Factors