Quality improvement (QI) research has rarely intersected with health disparities research, with the result that few quality improvement initiatives have been aimed specifically at reducing disparities; even fewer have been aimed specifically at QI and children’s health disparities. The authors provide a list of lessons learned from adult QI literature, as well as a list of necessary components for systematic reduction in health disparities. Finally, the authors reviewed several initiatives aimed at reducing disparities and improving quality of care for children.
The authors identified six necessary components to reduce disparities: stratify performance data by race, ethnicity, insurance and socioeconomic status; obtain training in working with diverse populations; make reducing inequities in care part of QI initiatives; provide models for making improvements; offer incentives for improving care to vulnerable populations; and advocate for resources for the uninsured and allocate them accordingly. From adult literature, the following lessons can be learned: address and remove barriers; tailor QI initiatives to particular cultures; and use nurse-led interventions where appropriate as they are often successful.
Pediatric asthma and immunization interventions were studied to see what made them successful. Community outreach was an important part of multiple interventions in these categories; family outreach was also important, and multidisciplinary teams that closely tracked patients were often successful. The authors conclude that general principles for reducing disparities and improving quality are both known; they must be applied to children’s health in order to reduce disparities as soon as possible.