A patient-informed approach to measuring and mitigating inequity in primary care - Project Summary/ Abstract
Racial and ethnic health inequities persist despite decades of evidence showing how societal structures drove
their development. Quality improvement (QI Initiatives, seemingly intended to promote equity, have great
potential to exacerbate disparities if there is not intentional focus on benefitting the population(s) experiencing
inequity. Attempts at equity-focused QI have underperformed by 1) focusing on improvement for all, rather than
on erasing disparities, 2) deploying a top-down stakeholder approach, rather than a community-informed
approach, 3) lacking a framework for considering quality measures through the contexts of systemic racism,
and 4) prioritizing ease of measurement over measures that are a priority to patients and communities. Recent
calls have been made for QI interventions that leverage partnerships between communities experiencing
inequities, providers serving these populations, and QI researchers to reduce health care disparities using
outcome measures that measure quality in ways meaningful to all stakeholders. Data and technology can be
harnessed to improve health equity by stratifying electronic health record (EHR) data by race, ethnicity, and
language (REaL) to create equity-focused QI dashboards to identify inequitable patterns in clinical processes
and health outcomes and inform QI initiatives to reverse them. However, if dashboard metrics and the
interventions to address them are not cooperatively designed by patients and providers, this limits their
influence and effectiveness. The study proposed within this K-Award is intended to be a first step in a larger
program of research that will serve to bridge health inequities research with medical informatics tools at the
intersection of Quality Improvement and Implementation Science, by 1) Identifying healthcare quality measures
using a community-informed, equity-focused approach, 2) Incorporate community-informed healthcare quality
measures into QI dashboards, and 3) using community-engaged intervention mapping to design strategies to
decrease health inequity. Equity-focused dashboards will provide concrete, real-time data to both inform
strategies and measure improvement, whether they be advanced structural competency training for providers,
changes to clinic policy and workflow, or interventions to address unmet social needs. This career
development award is designed to provide critical training in the fundamentals of quality improvement,
implementation science, community-engaged intervention design, and medical informatics that are necessary
for developing community-informed, practical, and measurable approaches to decrease racial health inequities
in primary care populations. This K01 will facilitate the development of patient-informed quality indicators and
innovative implementation strategies to improve health equity in primary care. The proposed study is
responding to the AHRQ Special Emphasis Notice for Health Services Research to Advance Health Equity
(NOT-HS-23-013).
