Implementing Quality Improvement to Reduce Disparities: The Case of the Health Disparities Collaboratives

1. Implementing Quality Improvement to Reduce Disparities: The Case of the Health Disparities Collaboratives Marshall H. Chin, MD, MPH Associate Professor of Medicine University of Chicago Director, RWJF Finding Answers: Disparities Research for Change National Program Office

7. Plan-Do-Study-Act Cycles (PDSA) Associates in Learning / Institute for Healthcare Improvement

8. Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes Delivery System Design Decision Support Clinical Information Systems Self- Management Support Health System Resources and Policies Community Health Care Organization MacColl Institute Chronic Care Model

15. Long-term Clinical (2-4 years): Processes of Care (%) Chin et al. Medical Care. In press. 41 37 22 Aspirin 50 42 33 ACE inhibitor 70 65 52 Lipid assessment 92 88 71 At least 1 A1c 2002 2000 1998 Process of Care

16. Long-term Clinical: Outcomes Chin et al. Medical Care. In press. 78 80 79 Diastolic BP (mm Hg) 133 135 133 Systolic BP (mm Hg) 108 116 127 LDL (mg/dl) 7.9 8.5 8.6 HbA1c (%) 2002 2000 1998 Outcome

18. Base Case Results ICER = $33,386/QALY $101,770 10.93 24 20 15 15 Program 2: With HDC $90,085 Lifetime costs, mean 10.58 Quality-adjusted life years, mean 28 CHD,% 20 Amputation,% 18 ESRD,% 17 Blindness,% Program 1: Without HDC

24. Wish List from Bureau of Primary Health Care 20 Training in quality improvement techniques 18 Information system technical support 26 Staff time spent on quality improvement 34 Data entry activities 44 Direct patient care services Percentage Ranked #1