March 5, 2004

Addressing inequality in health care: MGH Disparities Committee report

Some studies have shown that despite advances in the modern medical system, racial and ethnic minorities still receive less care and/or lower quality care than white Americans. This message was reinforced when former Surgeon General David Satcher, MD, presented startling data on the issue of racial and ethnic disparities during a visit to the MGH in 2002. Since his visit, the hospital has embarked on an important mission to address these issues within the MGH community and beyond.

The crux of Satcher's presentation — which he also gave to the Boston Public Health Commission — highlighted findings from the Institute of Medicine's (IOM) report "Unequal Treatment,"which found that minorities receive lower quality health care than whites even when insurance status, income, age and severity of illness are comparable. The report also emphasized that differences in treating heart disease, cancer and HIV infection partly contribute to higher death rates among minority groups (See below for findings from the IOM report).

Boston Mayor Thomas Menino heard Satcher's message and subsequently invited the presidents of all Boston hospitals — including Peter L. Slavin, MD, MGH president — to participate in a citywide effort to address issues of racial inequality in the health care arena. Satcher's message was the catalyst; Mayor Menino issued a call to action; Slavin spearheaded the efforts at the MGH.

"The information from the IOM report is compelling," says Slavin. "It isn't a question of whether disparities exist or not. They do exist. I hope the MGH can be a true leader in developing policies and strategies to help reduce these inequities and eventually eliminate them."

David Torchiana, MD, chairman and CEO of the Massachusetts General Physicians Organization, adds, "Fortunately, as an institution we have the resources and superb people with the right skill sets to begin to address the issues raised."

What is being done at the MGH?

In February 2003, Slavin appointed Joseph Betancourt, MD, MPH, senior scientist at the MGH Institute of Health Policy and a member of the IOM study committee that produced "Unequal Treatment,"and Joan Quinlan, director of the MGH Community Benefit Program, as co-chairs of the newly formed MGH Disparities Committee. Under the auspices of the hospitalwide Diversity Committee, the Disparities Committee is charged with identifying key areas where racial disparities may exist at the MGH; developing solutions to address those disparities; and coordinating hospital efforts with Mayor Menino's citywide initiative.

The committee, which is comprised of MGH staff from various administrative, clinical and patient care areas, has met on a quarterly basis to establish a process for addressing disparity issues at the MGH. "We know from the national data that racial disparities in health care do exist," says Betancourt. "Our goal is to be proactive at the MGH regarding disparities and to explore potential approaches to address these issues in thoughtful and constructive ways. Eliminating these disparities follows the tradition that is a crucial part of the MGH's mission established many years ago Ð to provide the highest quality of care for all patients."

Because of the depth and breadth of the committee's charge, three subgroups were formed to develop detailed plans move forward with the committee's goals into 2004. The Quality subcommittee is charged with developing methods for including racial and ethnicity measures into ongoing quality monitoring and improvement initiatives. The Patient Experience and Access subcommittee is charged with evaluating the experience of care at the MGH and evaluating barriers some patients may encounter in accessing care. The Education and Awareness subcommittee will develop a plan to raise awareness regarding disparities and the factors that contribute to them.

"The plans the subgroups have developed so far have been remarkably comprehensive and build upon efforts that are already under way at the MGH,"says Quinlan. "A great deal of work has been done under the leadership of the Diversity Committee to address issues that help eliminate disparities, such as a more diverse workforce and clinician education in providing culturally competent care. The work of these subgroups will help build on this foundation and move us closer to eliminating disparities."

For more information about the Disparities Committee, call (617) 724-2763. For more information about the IOM report, visit www.iom.edu.

Key findings from the 2002 IOM report:

• Racial and ethnic disparities in health care exist and are unacceptable.
• Disparities occur in the context of persistent racial and ethnic discrimination in many sectors of American life.
• Many sources — health systems, health care providers, patients and utilization managers — contribute to racial and ethnic disparities in health care.
• Bias, stereotyping, prejudice and clinical uncertainty on the part of health care providers may contribute to racial and ethnic disparities in health care.
• Racial and ethnic minority patients are more likely than white patients to refuse treatment, but differences in refusal rates are generally small, and do not fully explain health care disparities.

IOM recommendations to address disparity issues:

• Increase awareness of existence of disparities among key health care stakeholders.
• Address systems of care, such as:
  
  Race/ethnicity/language preference/data collection*
  Quality improvement to address disparities*
  Health care workforce diversity improvement efforts**
  Interpretation services**
  Use of community health workers**
  Provider education**
  Patient education*
  Research**
  
  * Areas the MGH is targeting
  ** Efforts already under way at the MGH