This application is in response to a request by AHRQ (RFA HS-02-005) for investigators to assess the impact of the Health Disparities Collaboratives on the processes and outcomes of care provided to patients cared for at participating health centers. We will study health centers that participated in the Diabetes II and Diabetes III Collaboratives, the Cardiovascular Collaborative, and the Asthma I and II Collaboratives. We will describe the interventions implemented by participating health centers; the patient populations served by the centers; the structure, staffing, organization, management, leadership, and culture of the centers; and the external partnerships formed with local, state, and national organizations. We will achieve this by conducting interviews with key clinical and administrative leaders at the health centers and the regional clusters; by reviewing monthly reports submitted by health centers to their Cluster Directors; and by reviewing other materials generated by staff from health centers and clusters. In addition to using these data to document what the health centers have accomplished, we will combine them with information on the processes and outcomes of care collected from patients' medical records and address the following specific aims: 1)evaluate whether participation in a Health Disparities Collaborative leads to improved processes and outcomes of care. and 2)identify the characteristics of the health centers, improvement teams, and improvement methods associated with positive change in quality of care. For each disease, we will sample 15 health centers that participated in a Collaborative and collect processes of care and outcomes data from the medical charts of 35 patients per center who received care prior to participation and 35 patients per center who received care following participation. The same number of patients with one of the conditions not targeted for intervention will be sampled at each of these health centers. The latter patients will comprise one of the control samples for our analyses. In addition, from a matched sample of 15 health centers that did not participate in a Collaborative, but that are otherwise eligible to do so, we will collect data from medical records of 70 patients per center per condition. Half of these patients will be sampled to coincide with a time period prior to the Collaboratives and half will be sampled to coincide with a period following the Collaboratives. These patients represent a second control sample for our analyses. Overall, we will study a total of 60 health centers and 9,450 patients (3,150 per condition). The results of this study will indicate whether the Health Disparities Collaboratives are nearer their goal of providing 100 percent access and eliminating disparities.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZHS1-HSR-S (01))
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Hsia, David
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Harvard University
Schools of Medicine
United States
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Landon, Bruce E; O'Malley, A James; Keegan, Thomas (2010) Can choice of the sample population affect perceived performance: implications for performance assessment. J Gen Intern Med 25:104-9
Hicks, LeRoi S; O'Malley, A James; Lieu, Tracy A et al. (2010) Impact of health disparities collaboratives on racial/ethnic and insurance disparities in US community health centers. Arch Intern Med 170:279-86