A quality improvement framework for equity in cardiovascular care: results of a national collaborative.

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.

The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters-a program funded by the Robert Wood Johnson Foundation (RWJF)-has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities. This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program.

Residents' awareness of racial and ethnic disparities in cardiovascular care.

PURPOSE: To characterize attitudes of residents toward racial/ethnic disparities in health care and to explore the effect of a simple intervention to improve awareness of these disparities. METHODS: The authors surveyed residents in internal and emergency medicine rotating through the Coronary Care Unit of a major teaching hospital about their attitudes toward disparities in cardiovascular care before and after an intervention that fostered discussion of evidence for the existence of disparities, possible causes of disparities, and clinically focused approaches to quality improvement tailored to the residents' practice environment. RESULTS: Before the intervention, 35% of residents agreed that racial/ethnic disparities might occur for patients within the US health care system in general, and only 7% agreed that patients they personally treated might experience racial/ethnic disparities in healthcare. These proportions increased significantly after the intervention: 85% agreement at level of US health care system and 32% at the level of individual practice (P < .001). Changes in awareness did not differ by sex, postgraduate year of training, race/ethnicity, reported prior diversity training, or plans to subspecialize. CONCLUSION: Awareness of racial/ethnic disparities in care among residents remains low, particularly at the level of individual practice, but is amenable to intervention.

Assumed equity: early observations from the first hospital disparities collaborative.

Disparities in healthcare represent a failure in the equity domain of quality. Although disparities have been well documented, little has been written about how hospitals might use improved data collection and quality improvement techniques to eliminate disparities. This article describes early findings from the planning phase of the first hospital-based disparities collaborative. The authors also discuss the changes in policy and practice that may speed hospitals in placing disparities and equity on their quality agendas.