Inequality in Quality

TLDR

Socioeconomic and racial/ethnic disparities in health care quality are well documented, yet monitoring and addressing them through organizational quality improvement remains limited. The authors review literature on disparities and highlight limitations in current quality assessment for identifying and addressing these disparities. They propose five principles to address disparities via modifications in quality performance measures, including stratification, adjustment, and payment strategies based on race/ethnicity and socioeconomic position.

Abstract

Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented. Recently, the elimination of disparities in health care has become the focus of a national initiative. Yet, there is little effort to monitor and address disparities in health care through organizational quality improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for identifying and addressing these disparities. We propose 5 principles to address these disparities through modifications in quality performance measures: disparities represent a significant quality problem; current data collection efforts are inadequate to identify and address disparities; clinical performance measures should be stratified by race/ethnicity and socioeconomic position for public reporting; population-wide monitoring should incorporate adjustment for race/ethnicity and socioeconomic position; and strategies to adjust payment for race/ethnicity and socioeconomic position should be considered to reflect the known effects of both on morbidity.