Americans are living longer, but with chronic conditions—such as diabetes, hypertension, heart disease and asthma—that require ongoing, high-quality health care. Yet new research reveals serious gaps in our system, in both the quality of care and how that care is provided to people in racial and ethnic minority groups.

A landmark RAND Health study initiated by RWJF found that widespread deficiencies in health care quality pose “serious threats to the health of the American public” that could contribute to thousands of preventable deaths each year. For example, only 45 percent of the studied patients who had suffered heart attacks received drugs that could cut their risk of death by more than 20 percent. The RAND findings, published in the New England Journal of Medicine, shattered the conventional wisdom about the exceptional quality of health care in the United States.

The Foundation addresses the quality dilemma on several fronts. RWJF is joining with providers, purchasers and others to establish standards for measuring health care quality, develop a framework for reporting those measures publicly, and create incentives for improving care.

With the Commonwealth Fund and the National Quality Forum, RWJF is seeking to achieve consensus across the health care system on a standard set of outpatient quality performance measures and to improve existing measures and data collection methods.

The Leapfrog Group, with Foundation support, is exploring one model for reporting those measures publicly, encouraging hospitals to report their quality measures on a voluntary basis. Leapfrog also serves as the national program office for Rewarding Results, funded jointly by RWJF and the California HealthCare Foundation to encourage health plans and purchasers to provide incentives that reward high-quality health care. One Rewarding Results project, Bridges to Excellence, is working in three cities—Boston, Louisville and Cincinnati—to test the effectiveness of incentives to improve the quality of care.

The ever-expanding use of the Internet, combined with emerging information technologies, also offers new opportunities for enhancing the quality of care. The Foundation’s Health e-Technologies initiative has awarded 19 grants to assess a range of projects, including Web-based weight management programs and one using e-mail in the workplace to encourage healthy behavior.

Similarly, Prescription for Health, a program co-sponsored by the Foundation, the federal Agency for Healthcare Research and Quality, and the National Institutes of Health, is field-testing promising models for improving everyday clinical practice among 17 primary care practice-based research networks.

The quality of care received by the frail elderly and others with chronic conditions depends on the competence and dedication of their caregivers. Better Jobs, Better Care, a program funded jointly by the Foundation and the Atlantic Philanthropies, seeks to improve recruitment and retention of high-quality nursing assistants, home health aides, personal care attendants and other caregivers working in long-term care settings. In 2003, the program funded five projects in Pennsylvania, Vermont, Iowa, North Carolina and Oregon to expand and promote innovative workforce policies and practices.

Our health care system must provide high-quality care to all Americans. The Institute of Medicine has documented that persons from racial and ethnic minority groups receive lower-quality health care than whites, even when their insurance status, income, age and severity of condition are comparable.

We still know too little about how patients from diverse racial and ethnic backgrounds receive care, especially for specific chronic conditions such as diabetes, cardiac disease and kidney disease. Having and applying such information is an essential first step toward reducing the unconscionable racial and ethnic disparities that plague our health care systems.

To that end, systems need to track the race or ethnicity of patients receiving care. Because this approach raises potentially sensitive issues, the Foundation in 2003 supported research, conducted by the American Association of Health Plans (now AAHP/HIAA) and Public Opinion Strategies, to better understand the views of health plans and diverse consumers, identify potential barriers to collecting needed information, and establish safeguards for gathering patients’ racial and ethnic information.