The objectives of this project were 1) to create a monitoring and evaluation tool (M&E) to identify the differences in health determinants and disparities in care among the patients of a planned federally qualified community health center (FQHC) and 2) to provide a framework for utilization of the M&E tool as a strategy for the center’s continuous quality improvement.
Health disparities are an important but often overlooked component of health care quality and are drivers of increasing health care costs. Over $300 billion per year is lost from the economy due to the direct and indirect costs of health care disparities. Currently, many health systems are reporting on health disparities using dashboards or report cards. Most of the reporting is done at system wide level on an annual basis. However, many quality improvement efforts need data in a timelier manner such as on a weekly or monthly basis. There is a dearth of tools which report on health disparities on a weekly or monthly basis.
A literature review using PubMed as the primary source for health care disparity measurement and a review of national, state, and municipal disparity reports were performed. Key variables were identified from this review based on frequency of occurrence, applicability to ambulatory care, and known social determinants of health. Baseline disparities within the geographic area for the planned community health center were identified from data provided by the Boston Public Health Commission and the Massachusetts Department of Public Health. Clinical priority areas for improvement were determined based on the magnitude of the disparity identified. A review of outcome metrics from national quality organizations related to the priority areas was performed. Metrics chosen were based on the frequency of occurrence and applicability to ambulatory care.
Key variables identified from the structured review were age, sex, race/ethnicity, place of birth, sexual orientation, food security, neighborhood security, socioeconomic status, employment status, housing status, insurance type/status, history of chronic diseases, and disability status. Priority areas identified were asthma care, diabetes care, hypertension care, mental health, and oral health. There were between five to twelve metrics chosen for each priority area. From these results, a questionnaire and database were created. Together the questionnaire and database will serve as M&E tools for measuring and monitoring disparities and health outcomes in the priority areas. A framework to guide ongoing implementation and utilization of these tools was developed.
Future Directions: A pilot test of the tool will be conducted, with both patients and providers once the center is opened in July 2015. Additional research will focus on the effectiveness of the tool to reduce disparities within the clinic and the reduction of disparities compared to other clinics in the hospital system.
Zoila Feldman, Chief Expansion Officer, North End Waterfront Health
Anne R. Murray-Chiriboga, North End Waterfront Health