Measuring Readiness to REduce Disparities and Improve QUality In Primary Care (EQUIP)

ABSTRACT Disparities in healthcare quality and health outcomes for Black patients compared to White patients have been demonstrated across a range of diseases even after accounting for access to care. In addition, studies document poorer health outcomes for Black compared to White patients who receive care within the same hospital or practice. However, these disparities vary in magnitude across facilities, highlighting the potential role of healthcare processes in reducing disparities. Yet, there are no validated measures of healthcare practice-level factors which may improve quality and reduce health disparities. Extending research on patient, provider, and neighborhood characteristics associated with health outcomes for Black patients, in this application, we focus on practices, policies, processes, and norms within a healthcare setting which may reduce disparities in health outcomes between White and Black or other racial and ethnic minority groups. Factors such as provider background and training, standardized processes to facilitate evidence-based care, and continuous quality improvement have been proposed as important to practice-based efforts to reduce disparities. However, to-date, no rigorously validated measure of practice-level readiness (capacity and preparedness) to reduce disparities exists. The goals of this research are: (1) to develop a measure that can be used to identify practice-level processes that indicate readiness to reduce disparities, and (2) determine its association with variation in Black-White disparities in health outcomes across practice settings. Because high quality primary care results in better health outcomes and reduced disparities, we propose a collaboration with primary care practice-based research networks (PBRNs) across the Southeast. We will use the infrastructure of PBRNs to conduct in-depth interviews with patients, providers, and clinic leaders and access electronic health record data (EHR) for patients across approximately 100 clinics to achieve the following Specific Aims: (1) Conduct in-depth interviews with patients, staff, providers, and healthcare leaders to identify perceived factors related to disparities and practice level processes which may reduce disparities between Non-Hispanic Black and White patients. (2) Design, pre-test, and determine the psychometric properties of a measure (EQUIP) to identify-practice level readiness to reduce disparities and improve health outcomes for Black patients. (3) Explore the modifying effects of practice-level readiness to reduce disparities, as measured by EQUIP, on the relationship between neighborhood-level factors (income, educational attainment, employment, healthcare access) and health outcomes (cancer screening, blood pressure control, etc.) for Black patients. This proposal to develop a validated measure of practice-level processes to reduce disparities is necessary to inform practice-level interventions which improve health for all. 3