title: A quality improvement framework for equity in cardiovascular care: results of a national collaborative.
abstract: Disparities in the quality of cardiovascular care provided to minorities have been well documented, but less is known about the use of quality improvement methods to eliminate these disparities. Measurement is also often impeded by a lack of reliable patient demographic data. The objective of this study was to assess the ability of hospitals with large minority populations to measure and improve the care rendered to Black and Hispanic patients. The Expecting Success: Excellence in Cardiac Care project utilized the standardized collection of self-reported patient race, ethnicity, and language data to generate stratified performance measures for cardiac care coupled with evidence-based practice tools in a national competitively selected sample of 10 hospitals with high cardiac volumes and largely minority patient populations. Main outcomes included changes in nationally recognized measures of acute myocardial infarction and heart failure quality of care and 2 composite measures, stratified by patient demographic characteristics. Quality improved significantly at 7 of the 10 hospitals as gauged by composite measures (p < .05), and improvements exceeded those observed nationally for all hospitals. Three of 10 hospitals found racial or ethnic disparities which were eliminated in the course of the project. Clinicians and institutions were able to join the standardized collection of self-reported patient demographic data to evidence-based measures and quality improvement tools to improve the care of minorities and eliminate disparities in care. This framework may be replicable to ensure equity in other clinical areas.
authors.affiliation: Center for Health Care Quality at the George WashingtonUniversity, Washington, DC, USA. bsiegel@naph.org
authors.forename: Bruce
authors.initials: B
authors.lastname: Siegel
authors.forename: Vickie
authors.initials: V
authors.lastname: Sears
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Bretsch
authors.forename: Marcia
authors.initials: M
authors.lastname: Wilson
authors.forename: Karen C
authors.initials: KC
authors.lastname: Jones
authors.forename: Holly
authors.initials: H
authors.lastname: Mead
authors.forename: Romana
authors.initials: R
authors.lastname: Hasnain-Wynia
authors.forename: Rochelle Knowles
authors.initials: RK
authors.lastname: Ayala
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhalla
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Cornue
authors.forename: Christina Marie
authors.initials: CM
authors.lastname: Emrich
authors.forename: Paru
authors.initials: P
authors.lastname: Patel
authors.forename: Jean R
authors.initials: JR
authors.lastname: Setzer
authors.forename: Jennifer
authors.initials: J
authors.lastname: Suitonu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Kim Allan
authors.initials: KA
authors.lastname: Eagle
authors.forename: Michael D
authors.initials: MD
authors.lastname: Winniford
mesh_terms: D001741:Black or African American; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards; D003299:Cooperative Behavior; D006265:Health Care Coalitions / Q000458:organization & administration* / Q000592:standards; D054625:Healthcare Disparities / Q000458:organization & administration* / Q000592:standards; D006333:Heart Failure / Q000208:ethnology / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D054525:Minority Health; D009203:Myocardial Infarction / Q000208:ethnology / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000458:organization & administration* / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States / Q000453:epidemiology