title: Partnering health disparities research with quality improvement science in pediatrics.
abstract: Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and.
authors.forename: K Casey
authors.initials: KC
authors.lastname: Lion
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Houston, Texas casey.lion@seattlechildrens.org.
authors.forename: Jean L
authors.initials: JL
authors.lastname: Raphael
mesh_terms: D002648:Child; D019058:Community Networks / Q000458:organization & administration; D003299:Cooperative Behavior; D006284:Health Plan Implementation / Q000458:organization & administration; D006302:Health Services Research / Q000458:organization & administration; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D033183:Interdisciplinary Communication; D010372:Pediatrics; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration*; D064890:Social Determinants of Health; D014481:United States; D035862:Vulnerable Populations
keywords: community health; health care disparity; quality improvement