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Tools and Guides for Disparities Solutions

The Disparities Solutions Center has released several publications that highlight practical solutions to identify and address disparities within hospitals and other health care oganizations. We also feature other resources related to health care disparities elimination.

Resources Produced by the Disparities Solutions Center

Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals and TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module
Healthcare Disparities Measurement
Improving Quality and Achieving Equity: A Guide for Hospital Leaders
Assuring HealthCare Quality: A Healthcare Equity Blueprint
Creating Equity Reports: A Guide for Hospitals

Resources Developed in Partnership with the Disparities Solutions Center
Solutions to Healthcare Disparities: Moving Beyond Documentation of Differences
Supporting Small Practices: Lessons for Health Reform

Other Disparites Resources
HHS Advisory Committee on Minority Health: A Statement of Principles and Recommendations
Center for Prevention and Health Services Issue Brief
Center for Health Professions - ACTION Initiative
Kaiser Permanente - A Provider's Handbook on Culturally Competent Care
American Hospital Association - Eliminating Disparities: Why it's Essential and How to Get it Done

Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals and TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module

The Disparities Solutions Center at MGH and Abt Associates, Inc. in Cambridge, MA, were awarded a four year contract by the Agency for Healthcare Research and Quality (AHRQ) to develop tools to reduce medical errors and improve care for LEP patients in hospitals. The project used a robust mixed methods approach to 1) identify the role of language and cultural barriers on patient safety events; 2) document how hospitals are addressing the safety of LEP and culturally diverse patients; and 3) provide guidance and tools for how hospitals can address these issues. The final products include a Hospital Guide and a TeamSTEPPS Training Module focused on improving team communication to reduce medical errors for LEP patients.

The Hospital Guide provides quality and safety leaders within hospitals with a variety of key guidelines and strategies for identifying, reporting, and addressing medical errors that occur as a result of language barriers in LEP and culturally diverse patients. The Guide also provides hospital leaders with systems-level information on how to develop reporting systems that can successfully capture medical errors that predominantly affect LEP patients, as well as modalities that can be implemented to prevent errors for LEP and culturally diverse patients. The TeamSTEPPS training module is designed for the full interprofessional care team, including interpreters, and includes a case-based video vignette of an LEP patient in the emergency room. The goal of the Module is to help the interprofessional care team acquire the knowledge, attitudes and behaviors needed to reduce the number and severity of patient safety events that affect LEP and culturally diverse patients.

Download the Complete Guide (pdf)
View the Web-Based Guide

View the TeamSTEPPS Module

Healthcare Disparities Measurement

The report on Healthcare Disparities Measurement provides practical recommendations for healthcare organizations to increase their portfolio of race, ethnicity, and language data collection strategies - and consequently, utilize that data to develop disparities-sensitive measures. This report is intended to guide organizations in disparities and quality measurement through the following strategies:

  1. Data Collection: Building the Foundation
  2. Disparities Measures and Indicators: What to measure
  3. Methodological Approaches to Disparities Measurement: How to Measure and Monitor
  4. Priorities and Options for Quality Improvement and Public Reporting of Healthcare Disparities

Download the complete report

Improving Quality and Achieving Equity: A Guide for Hospital Leaders

The Disparities Solutions Center at Massachusetts General Hospital, with support from the Robert Wood Johnson Foundation, is proud to annouce the release of Improving Quality and Achieving Equity: A Guide for Hospital Leaders. 

The Institute of Medicine (IOM) Report Crossing the Quality Chasm, released in 2001, highlights that there is a significant gap between the quality of health care people should receive, and the quality of health care people do receive. Just a year later, the IOM released another influential report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, highlighting an even larger quality chasm for racial/ethnic minorities in the United States.

Over the last few years, there has been an increased focus by hospital leadership on improving quality by responding to the six key elements proposed in Crossing the Quality Chasm. In regards to equity, research has shown that racial and ethnic disparities in health care have an impact on quality, safety, cost, and risk management. Addressing disparities has now been acknowledged by the National Quality Forum and the Joint Commission as essential component of quality. Despite this, few hospital leaders have the issue of equity, and identifying and addressing disparities, prominently on their radar screen.

The goals of this Guide are to:

  1. Highlight the evidence for racial and ethnic disparities in health care and provide the rationale for addressing them—with a focus on quality, cost, risk management and accreditation.
  2. Highlight model practices—hospitals and leaders who are actively engaged in addressing disparities and achieving equity.
  3. Recommend a set of activities and resources that can help hospital leaders initiate an agenda for action in this area.

View Web-Based Report
Download the Complete Guide
Download Executive Summary

Assuring Healthcare Quality: A Healthcare Equity Blueprint

The Healthcare Equity Blueprint offers strategies and practices that can be tailored to individual hospitals to address equity in providing quality care. The Blueprint is a starting point for designing and implementing interventions to address racial and ethnic disparities in health care. Aspects of this Blueprint apply to numerous health care settings, but the primary focus is on hospitals. In addition, the Blueprint should be considered "a work in progress, "to be improved and modified by hospitals that use it."

The proposed improvement strategies are grouped into the following five categories:

  1. Create Partnerships with the Community, Patients, and Families
  2. Exercise Governance and Executive Leadership for Providing Quality and Equitable Care
  3. Provide Evidence-Based Care to All Patients in a Culturally and Linguistically Appropriate Manner
  4. Establish Measures for Equitable Care
  5. Communicate in the Patient’s Language — Understand and be Responsive to Cultural Needs and Expectations

The Blueprint also provides recommended tools, resources, and guidelines on the collection and measurement of data related to addressing health care disparities.

Executives and governing bodies may use this Blueprint to organize and prioritize the goals, strategies, expected outcomes, and performance benchmarks for addressing health care equity within their established strategic planning process. Working groups within the hospital may identify specific changes in care and support operations that can be tested initially on a small scale within an organizational unit.

Download the Complete Report.

Creating Equity Reports: A Guide for Hospitals*

Just as a quality report allows hospital executives, physicians, and staff to examine quality of care across multiple dimensions, an equity report highlights potential inequalities in utilization, care processes, outcomes, and patient experiences with care. By building on existing quality reporting efforts, an equity report helps examine the extent to which a hospital provides equally high quality care to all patients, regardless of their race, ethnicity, language, socioeconomic status, and other characteristics.

Creating Equity Reports: A Guide for Hospitals is a resource that can help your staff develop an equity report. The Guide provides practical information on how to collect data on race, ethnicity, language, and socioeconomic status – and how to use those data to develop an equity report that will allow your hospital to take action.

Download the Complete Guide
Download an Executive Summary for Hospital Leaders
View an archive of the web seminar featuring this tool

*Funded by the generous support of the Robert Wood Johnson Foundation, with additional support from the Office of the Attorney General of Massachusetts

Solutions to Health Care Disparities: Moving Beyond Documentation of Differences

The research community has thoroughly documented the existence of racial and ethnic disparities in health and health care in the United States. Experts in the field are now concerned with moving from documentation of differences toward efforts to actually eliminate disparities in health care.

Three recent examples illustrate potential strategies for reducing disparities. These interventions targeted specific disparities in three areas—premature birth, diabetes care, and physician service quality. Analysis of these interventions suggests that they all share certain elements in common.They contained multiple components to target different points in the health care system, they were culturally appropriate, and they made extensive use of data from health information technology (HIT) to identify characteristics of individuals affected by disparities and to allow successful interventions to be replicable. The goal of this project is to demonstrate that moving forward with disparities reduction and addressing barriers on a national level will require engagement from the research community and leaders of health care systems.

Download the Complete Report

Supporting Small Practices: Lessons for Health Reform

Small medical practices play an important role in the care of patients with diverse needs. These practices often have limited infrastructure and face significant barriers to providing the highest quality health care. If small practices are to provide accessible, effective and efficient care for vulnerable patients, they will need additional attention, resources and support. Given the proportion of care these practices provide, especially in underserved urban and rural areas, failure to provide adequate help in adapting to the new demands for health information technology, quality and accountability could greatly impair the chances for successful health care reform.

To understand the needs of small practices in providing the best quality care, the National Committee for Quality Assurance (NCQA) launched a quality improvement demonstration program for small physician practices serving minority populations. With funding from The California Endowment, NCQA provided grants and technical assistance to small practices (5 physicians or fewer). The goal of the project was to learn what types of resources and tools these practices need in order to conduct and sustain quality improvement activities, especially for serving disadvantaged populations.

Download the Complete Report.


Non-DSC Sponsored Resources

HHS Advisory Committee on Minority Health

The HHS Advisory Committee on Minority Health recently released a statement of principles and recommendations - Ensuring that Health Care Reform will meet the Health Needs of Minority Communities and Eliminate Health Disparities.


Center for Prevention and Health Services Issue Brief:
Eliminating Racial and Ethnic Disparities; A Business Case Update for Employers


Released February 2009 from the National Business Group on Health

The U.S. Census Bureau projects that race-based minorities, including Hispanics, African Americans and Asians, which currently represent one-third of the U.S. population, will become a majority in 2042. Employers need to be aware of these demographic shifts and to understand that in this new environment, a “one-size-fits-all” approach to employee health benefits will not be effective.

This Issue Brief will:
1. Explore key causes of health disparities in the U.S. and its workforce;
2. Make a case for why it is more important than ever for employers to address disparities
in health and health care; and
3. Present steps employers can take to address health disparities.

Center for Health Professions - ACTION Initiative

The ACTION program is accepting applications from organizations in California for technical assistance and seed funding from organizations looking to address equity of care using quality improvement approaches.

Technical assistance will be provided based on applicants’ needs and is likely to include the following areas: quality improvement methods, patient-provider communications, disease management, survey instruments, and quality dashboards.

To apply and for more information, please visit the ACTION website or download a factsheet.

Kaiser Permanente - A Provider's Handbook on Culturally Competent Care

See recent release, Women's Health Edition.
Kaiser Permanente is committed to providing linguistically and culturally competent care to its increasingly diverse membership. Meeting the needs of its membership and addressing the urgent national problem of disparities in health status and health care delivery require interventions that are respectful, patientcentered, and culturally skilled. One such intervention is the Provider Handbooks. The goal of the Provider Handbooks is to provide Kaiser Permanente clinicians with an overview of the cultural and epidemiological differences that characterize major cultural groups represented within our membership. The Handbooks focus on common characteristics of each group that may have implications for health care organizations and practitioners.

For more information, please see the recent Handbook women's health.

American Hospital Assocation

American Hospital Association highlights the Disparities Solutions Centers' efforts to reduce racial/ethnic disparities in Eliminating Disparities: Why it's Essential and How to Get it Done.