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More than 10 years ago, the Institute of Medicine rattled the nation with a disturbing report called "Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care," which revealed striking differences in the quality of medical care received by different populations. The report documented clearly that racial and ethnic minorities, when compared with the majority population, received lower quality care in areas such as the management of heart disease, diabetes and pain management for fractures.
While the findings of this report were appalling, the attention that resulted from its publication proved to be transformative – a game-changer. In the wake of this report, members of the health care community, public officials, community services and social service organizations came together to figure out ways to turn around this unacceptable reality. In Boston, Mayor Thomas Menino formed a citywide group to tackle the issue, and MGH was pleased to be part of the task force that developed a blueprint for eliminating disparities in the city. In parallel, at the MGH we formed the Committee on Racial and Ethnic Disparities, co-chaired by Joe Betancourt MD, MPH, who had served as a member of the IOM committee that produced the 2002 landmark report, and Joan Quinlan, Vice President for Community Health and the execuive director of the MGH Center for Community Health Improvement. Two years later, the hospital launched the Disparities Solutions Center, with Dr. Betancourt as its director. Addressing disparities has remained an institutional priority since then. In the ensuring years, we have captured and collected patient race and ethnicity data, identified areas in which disparities exist, created programs and systems that address problem areas, and developed tools to routinely measure and monitor progress. These efforts are paying off.
One tool developed at the MGH as part of this effort is a robust disparities dashboard – the first of its kind in the nation – that provides a framework for monitoring quality of care hospitalwide, identifying particular areas of concern and tracking the effectiveness of interventions. For example, our dashboard in 2005 indicated that only 35 percent of Latino patients at the Chelsea HealthCare Center who should have colorectal cancer screenings were getting them, compared with 45 percent of white individuals. In fact, rates for both groups were much lower than we would have liked. We put into place a navigator program to provide education and information about colorectal cancer screening, determine and address barriers that were keeping individuals from getting screened, and schedule appointments for patients – even accompany them when needed. Results of a follow-up survey in 2010 showed that nearly 75 percent of the targeted group of Latino patients had undergone a colonoscopy, compared with 67 percent of white patients. Rates for both groups had increased significantly, and the disparity was eradicated.
In addition, it has been gratifying to see that patients’ perceptions of care and their views about their health care experience at MGH have also improved. In 2004, the Disparities Solutions Center surveyed patients about issues related to race, ethnicity and health care, and at that time 21 percent of African-American and 25 percent of Hispanic/Latino patients reported that they thought they received lower quality care than white patients. In 2012, a similar survey conducted by Karen Donelan, ScD, and Estaban Barreto in the MGH’s Mongan Institute for Health Policy, found that those numbers had improved significantly, with only 6.6 percent of Hispanic/Latino patients and 9.1 percent of African-American patients feeling that the quality of their care was less than the care received by English-speaking, white patients. Survey data also showed that in this eight-year period, fewer African-American and Latino patients felt they were being treated unfairly or disrespectfully because of their race or ethnicity.
While we should celebrate this progress, we also know there is so much more to do. We are continually adding measures, looking into new areas and figuring out where we can have the most impact. At the MGH, for example, we have launched a number of safety initiatives focused on patients with limited English proficiency. We have begun to collect data on sexual orientation and disabilities to look for any differences in care. We are also examining readmissions to see if rates vary by race and ethnicity. Indeed our dashboard continues to evolve. In addition, we are sharing these successful efforts far beyond the MGH, as the work of the Disparities Solutions Center has become a national model. Since 2007, our Disparities Leadership Program, a yearlong executive educational course, has provided information to help organizations plan strategies, implement programs and measure effectiveness of disparity efforts. To date, more than 200 participants representing more than 100 health care organizations, including hospitals, health plans and community health centers from across the country – and even internationally – have participated in this program in which we share what we have learned and help other organizations to implement programs and enhance efforts aimed at eliminating disparities.
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