Key Disparities Research Questions Marshall H. Chin, MD, MPH Associate Professor of Medicine University of Chicago Director, RWJF Finding Answers: Disparities Research for Change NPO AcademyHealth June 26, 2006

Roadmap Finding Answers Finding Answers Key Questions Key Questions

Finding Answers Finding Answers: Disparities Research for Change seeks to improve the quality of health care provided to patients from racial and ethnic backgrounds likely to experience disparities. Finding Answers: Disparities Research for Change seeks to improve the quality of health care provided to patients from racial and ethnic backgrounds likely to experience disparities.

Goals Finding Answers will: Finding Answers will: –Grant funds to discover and evaluate practical and replicable solutions designed to reduce and eliminate racial and ethnic health care disparities. –Conduct systematic reviews regarding racial and ethnic health care disparities interventions. –Disseminate results.

Grants Cardiovascular disease, diabetes, depression Cardiovascular disease, diabetes, depression 3 Call for Proposals over 4 years 3 Call for Proposals over 4 years grants grants $5 million - $50K-$300K $5 million - $50K-$300K

Eligible Interventions Patient – e.g. disease management Patient – e.g. disease management Provider – e.g. cultural competency Provider – e.g. cultural competency Organization – e.g. QI Organization – e.g. QI Community linkage – e.g. CHW Community linkage – e.g. CHW Policy – e.g. P4P Policy – e.g. P4P

Call for Proposals Cycles Call for Proposals Cycle 1 Call for Proposals Cycle 1 –178 Brief Proposals –36 Full Proposal Invites –Grantees chosen October 2006 Call for Proposals Cycle 2 Call for Proposals Cycle 2 –Launch end of 2006 Call for Proposals Cycle 3 – late 2007 Call for Proposals Cycle 3 – late

Systematic Reviews: 3 Products Supplement to Med Care Research Review Supplement to Med Care Research Review Searchable database on website – CVD, DM, Depression Searchable database on website – CVD, DM, Depression Policy briefs Policy briefs

Med Care Research Review Intro Intro CVD CVD DM DM Depression Depression Breast cancer Breast cancer Culture-specific Culture-specific P4P and public reporting P4P and public reporting Policy Policy

Observations Lots of general QI interventions Lots of general QI interventions Relatively few studying minority populations Relatively few studying minority populations Vanishingly few on disparity reduction Vanishingly few on disparity reduction Holes Holes

Key Questions: Targeting Mix of general QI vs. culture-specific Mix of general QI vs. culture-specific –Raise the tide of all vs. target –All providers vs. predominant providers of minority patients –General QI techniques vs. culture-specific Operationalizing culture-specific Operationalizing culture-specific –Patient-centered and cultural competency –Physical and mental – e.g. stigma

Key Questions: Implementation Inside black box of implementation Inside black box of implementation Replicable - $, effort, practical tools Replicable - $, effort, practical tools Sustainable Sustainable Multicomponent – prioritization and resource allocation Multicomponent – prioritization and resource allocation Unintended consequences Unintended consequences –Positive –Negative

Key Questions: Cost Cost issues – business and societal Cost issues – business and societal –Aligning the incentives Resource capacity, esp. for predominant providers of minority patients Resource capacity, esp. for predominant providers of minority patients

Key Questions: Community and Policy Leverage full strengths of both community and health care system Leverage full strengths of both community and health care system –Public health and medical care –Community-based participatory research P4P, public reporting, financial incentives P4P, public reporting, financial incentives