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Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative

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Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities.

OBJECTIVES

To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care.

DESIGN

Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative.

PATIENTS

Black and white adults receiving care in an academic general internal medicine practice in Chicago.

INTERVENTIONS

The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services.

MAIN MEASURES

Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measures

KEY RESULTS

Quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative.

CONCLUSIONS

Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.

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Contributors

We would like to thank Andrew J. Cooper for his assistance with the time series analyses.

Funders

This study was funded in part by the Agency for Healthcare Research and Quality (grant no. 5R18HS017163) and the Aetna Foundation. Dr. Jean-Jacques was supported in part by Federal funds from the National Center for Research Resources (NCRR) and National Institutes of Health (NIH) through the Clinical and Translational Science Awards Program (CTSA) (Northwestern University UL1RR0254741). Dr. Persell was supported by career development award K08HS015647 from the Agency for Healthcare Research and Quality. Content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ, NIH, or Aetna Foundation.

Prior presentations

We presented an earlier version of this manuscript as an oral presentation at the 32nd Annual Meeting of the Society of General Internal Medicine in Miami, Florida, in May, 2009.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA

    Muriel Jean-Jacques MD, MAPP, Stephen D. Persell MD, MPH, Jason A. Thompson BA, Romana Hasnain-Wynia PhD & David W. Baker MD, MPH

  2. Center for Healthcare Equity, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Romana Hasnain-Wynia PhD

Authors
  1. Muriel Jean-Jacques MD, MAPP
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  2. Stephen D. Persell MD, MPH
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  3. Jason A. Thompson BA
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  4. Romana Hasnain-Wynia PhD
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  5. David W. Baker MD, MPH
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Corresponding author

Correspondence to Muriel Jean-Jacques MD, MAPP.

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Jean-Jacques, M., Persell, S.D., Thompson, J.A. et al. Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative. J GEN INTERN MED 27, 71–77 (2012). https://doi.org/10.1007/s11606-011-1842-2

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  • DOI: https://doi.org/10.1007/s11606-011-1842-2

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