May 2008

Grant Results

SUMMARY

Between June 2004 and December 2005, staff at the American Medical Association (AMA) conducted a series of planning activities designed to build and formalize the Commission to End Health Care Disparities. The commission, which originated in 2003, included specialty and state medical organizations and public health groups committed to eliminating racial and ethnic disparities in health care.

Key Results

  • The Commission to End Health Care Disparities has become a permanent organization with 58 members. It is dedicated to increasing awareness of racial and ethnic health care disparities among physicians and other health care professionals and implementing solutions to eliminate such disparities.
  • A survey of 28 member organizations found that 18 had "targeted health care disparities as a key issue for its members."
  • A national survey of 1,800 physicians found that more than half (55 percent) agreed that "minority patients generally receive lower quality care than white patients." Physicians believe they have appropriate training and skills to address health care disparities and are actively engaged in and optimistic about the issue.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the planning work with an unsolicited grant of $193,221 to the American Medical Association.

 See Grant Detail & Contact Information
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THE PROBLEM

A 2002 report by the Institute of Medicine, entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, examined differences in the health care of racial and ethnic minorities in the United States:

  • The report noted that "[r]acial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients' insurance status and income, are controlled."
  • The study committee "found evidence that stereotyping, biases, and uncertainty on the part of healthcare providers can all contribute to unequal treatment."

In response to the institute's report, the American Medical Association House of Delegates voted, in December 2002, to create a program on health care disparities. AMA staff believed that physicians and physician organizations could be catalysts in improving care for racial and ethnic minorities in the United States. However, a 2002 Kaiser Family Foundation National Survey of Physicians indicated that providers were not aware of this problem; a majority of physicians surveyed reported that disparities in health care treatment "rarely" or "never" happen because of race or ethnicity.

In October 2003, the AMA convened the leadership of 25 medical professional and specialty groups as the Federation Task Force on Disparities in Health Care to focus on the elimination of racial and ethnic disparities and the promotion of physicians as leaders in this effort.

Representatives of 34 medical professional and specialty organizations met a second time in April 2004. At that meeting, the group renamed itself the Commission to End Health Care Disparities and appointed four advisory committees to address four priority areas:

  • Professional Awareness—to raise awareness among physicians about health care disparities.
  • Data and Information Gathering—to identify data needs to help physicians understand the scope of the problem.
  • Education and Training—to develop and provide materials to physicians for addressing the issue of disparities.
  • Workforce Diversity—to promote diversity in recruitment for and leadership in the medical professions.

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RWJF STRATEGY

This grant was made in support of RWJF's then-current strategic objective to reduce racial and ethnic disparities in the care of targeted diseases by 2008. Toward that end, RWJF worked with health care plans, providers and purchasers to identify and reduce disparities in the delivery of evidence-based care provided to racial and ethnic subpopulations.

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THE PROJECT

Project staff from the American Medical Association conducted a series of planning activities designed to build and formalize the Commission to End Health Care Disparities.

Activities

Project staff convened two meetings of the commission, in July 2004 and in January 2005, and conducted three data-gathering activities:

  • Staff surveyed 34 member organizations about their policies and programs related to health care disparities in order to establish a baseline of activity at the commission's initiation. Some 28 organizations (82 percent) responded. See Findings.
  • Staff surveyed a nationally representative sample of 1,700 physicians that included extra numbers of physicians practicing in areas with high minority populations. The response rate was 52 percent. The survey built on the 2002 Kaiser Family Foundation National Survey of Physicians and addressed physicians' own experiences providing health care to racial and ethnic minorities. See Findings.

    Project staff also used the survey of physicians to develop a valid instrument to measure physician engagement in addressing racial and ethnic health care disparities. Researchers can use the resulting tool to evaluate the impact of interventions designed to increase physician involvement in ending health care disparities.
  • Staff conducted two sets of follow-up interviews (15 minutes and one hour) with respondents to the physician survey who provided contact information so they could share their efforts to reduce disparities in their own practices.

Communications

Project staff developed a Web site for the commission, which is located on the Web site of the American Medical Association. See the Bibliography for details.

The staff also created a commission speakers' bureau consisting of representatives of member organizations who speak at national and local events, medical schools and hospitals to increase awareness of and urge providers to become involved in eliminating health care disparities. Commission representatives presented the commission's work to the Sullivan Commission on Diversity in the Healthcare Workforce.

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RESULTS

Project staff reported results in a report entitled "Commission to End Health Care Disparities: 2005 Summary," which they distributed to member organizations and others in the health care community and posted on the commission Web site:

See the Bibliography for details.

Findings

Project staff reported findings from the survey of member organizations in an unpublished brief entitled "Programs and Policies to End Health Care Disparities: 2005 Survey of the Commission to End Health Care Disparities Member Organizations." Key findings include:

  • Some 18 of the 28 specialty and state medical societies surveyed said their organizations had "targeted health care disparities as a key issue for its members in the year 2004." The main areas of focus for their members included cultural competency, health care access and health literacy.
  • A majority (22) of professional organizations surveyed said they were involved with programs and activities for physician education and training on the disparities issue.
  • Some 14 organizations reported that they had developed or were developing "policies or resolutions related to the reduction of health disparities."
  • Some 14 organizations reported that they were involved in legislative activity to reduce disparities. Thirteen were involved at the federal level and nine at the state level or both.
  • The member organizations surveyed also engaged in other related activities:
    • Twelve established special interest groups or committees to address health care disparities.
    • Ten developed written materials on health care disparities.
    • Five assessed their own members' needs and interests regarding health care disparities.

Project staff reported findings of the survey of physicians in a 2005 brief posted on the commission Web site entitled "Physicians are Becoming Engaged in Addressing Disparities." Key findings included:

  • Physicians are aware that health care disparities are a problem (in contrast to the findings of the 2002 Kaiser Survey of Physicians mentioned above):
    • Over half (55 percent) of the physicians surveyed agreed that "minority patients generally receive lower quality care than white patients." About a quarter (24 percent) disagreed with this statement.
    • Almost two-thirds (62 percent) of the physicians reported witnessing "a patient receive poor quality health care because of the patient's race or ethnicity."
  • Physicians believe they have appropriate training and skills:
    • Most physicians surveyed (88 percent) reported that they had cared for members of minority population groups "often" or "very often" during their training.
    • Some 70 percent of physicians reported that they were "well informed about possible cultural differences between themselves and patients they may care for."
    • Some 41 percent reported fluency in a language other than English and 87 percent said they had cared for a patient within the past month who did not speak English fluently.
  • Physicians report active engagement in and optimism about the issue:
    • They read journal articles (54 percent), talk with community health workers (44 percent) or colleagues (32 percent) and attend meetings (19 percent).
    • A large majority of all physicians surveyed (89 percent) believe "it is possible to provide high quality care to all their patients." Minority physicians were significantly more likely to believe this than non-minority physicians (94 percent versus 87 percent).
  • Physicians face several barriers to their participation in improving the health care of minority patients. In particular they cited:
  • Time constraints (41 percent). Financial concerns (21 percent). Widespread poverty in their minority patients' home communities (20 percent). Difficulty obtaining non-emergency care at hospitals (13 percent).

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LESSONS LEARNED

  1. Ensure that staff commitment to the effort is nearly equal across leadership organizations when establishing a national "organization of organizations." Otherwise, the resulting entity may be viewed as "belonging" to the organization with the most resources. (Project Director)
  2. Create visible short-term projects that accelerate the buy-in process by member organizations. (Project Director)
  3. Use strong senior leadership to provide credibility to the development of the organization. (Project Director)
  4. Grant funding from RWJF and financial support from the AMA during the start-up period alleviated the need to ask member organizations for dues and that facilitating early buy-in. (Project Director)

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AFTER THE GRANT

Since the end of the RWJF grant, the Commission to End Health Care Disparities, as a permanent entity, has continued its work, staffed and financially supported mostly by the AMA. As of December 2006, the AMA was seeking to establish a regular dues structure with the member organizations to reduce the commission's reliance on the AMA for financial support.

Commission representatives, through the commission's speakers bureau, made more than 15 presentations (most occurring after the end of the RWJF grant period) to organizations throughout the United States. In 2007, representatives began offering workshops on eliminating racial and ethnic disparities in health care.

As of December 2006, project staff had submitted an article on the hour-long follow-up interviews of physicians to a peer-reviewed journal. They were also preparing an article on the 15-minute interviews. Staff also planned to submit a third article on the instrument developed to measure physician engagement in addressing health care disparities.

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GRANT DETAILS & CONTACT INFORMATION

Project

Developing a Strategic Plan for a Consortium of State and Medical Specialty Associations to Address Disparities in Health Care

Grantee

American Medical Association (Chicago,  IL)

  • Amount: $ 193,221
    Dates: June 2004 to December 2005
    ID#:  050105

Contact

Arthur B. Elster, M.D.
(312) 464-5530
Arthur.elster@ama-assn.org

Web Site

http://tinyurl.com/yfmfzqp

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Alexander GC, Lin S, Sayla MA and Wynia MK. "Development of a Measure of Physician Engagement in Addressing Racial and Ethnic Health Care Disparities." Health Services Research, 43(2): 773–784, 2008. Abstract available online.

Casalino LP and Elster A. "Will Pay-for-Performance and Quality Reporting Affect Health Care Disparities?" Health Affairs, 26(3): w405–w414. 2007. Abstract available online.

Vanderbilt SK, Wynia MK, Gadon M and Alexander GC. "A Qualitative Study of Physicians' Engagement in Reducing Health Care Disparities." Journal of the National Medical Association, 99(12): 1315–1322, 2007. Abstract available online.

Reports

Physicians Are Becoming Engaged in Addressing Disparities. (Preliminary Survey Brief) Chicago: American Medical Association, 2005. Available online.

Programs and Policies to End Health Care Disparities: 2005 Survey of the Commission to End Health Care Disparities Member Organizations. Chicago: American Medical Association, 2005.

Voelker R. Commission to End Health Care Disparities: 2005 Summary. Chicago: American Medical Association, 2005.

Survey Instruments

"Survey of the Commission to End Health Care Disparities Member Organizations," American Medical Association, fielded December 2004.

"Quality Health Care for Minorities: Understanding Physicians' Experiences," American Medical Association, fielded December 2004 to March 2005.

World Wide Web Sites

www.ama-assn.org/ama. "Commission to End Health Care Disparities" on the American Medical Association's Web site provides information about the commission, a timeline of its history and downloadable copies of the 2005 Summary report and a report on the survey of physicians. Chicago: American Medical Association, 2005.

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Report prepared by: Robert Rosenblatt
Reviewed by: Mary B. Geisz
Reviewed by: Marian Bass
Program Officer: Pamela Dickson