Supported by Finding Answers: Disparities Research for
Change, a National
Program of the Robert Wood Johnson Foundation with direction and technical assistance provided
by University of Chicago
Project Funded May 1, 2008- Two Years Funding
Problem Statement: Disparities
Certain racial and ethnic populations—African Americans, Latinos,
and American Indians—suffer from worse health and receive lower-quality
health care than Caucasians. In 2002 the Institute of Medicine released
Unequal Treatment: Confronting Racial and Ethnic Disparities in Health
Care, which summarized the results of hundreds of research studies showing
lower quality care for minority patients.
Recent research continues to show worse health outcomes for minority
populations and lower socioeconomic status groups:
African Americans received poorer quality care than Caucasians for 16
out of 22 (73%) core quality measures.
Hispanics received poorer quality care than Caucasians for 17 out of 22
(77%) core quality measures.
Poor people received worse quality care than those with high income for
12 out of 17 core quality measures.
(reprinted from the Robert Wood Johnson Foundation web site on Disparities)
While the existence of racial and ethnic health
care disparities has been firmly established, health
care systems have not found a practical blend of
strategies and interventions that measurably reduce
these differences. Without better knowledge about
practical steps to reduce disparities in care, health
care organizations are often unable to address these
gaps. Furthermore, recent research indicates that
most past efforts to close these gaps have either failed
or led to limited improvements. We need to move
beyond documenting health care disparities to finding
solutions that will eliminate them.
(reprinted from the Finding Answers: Disparities Research for Change, a National
Program of the Robert Wood Johnson Foundation at the University of Chicago)
Disparities in Diabetes Care in Eastern North Carolina
Data from the UKPDS study has clearly shown that improving glycemic and blood
pressure control in patients with diabetes can result in significant reductions
in both morbidity and mortality (see UKPDS 1998). The American Diabetes
Association and other entities have published guidelines for diabetes care
based on this and other evidence (see American Diabetes Association, 2007).
However, many patients, particularly rural minority patients, do not receive
these recommended levels of care, demonstrating the need for redesigning systems
of care to minimize long-term morbidity/mortality.
Rural minority patients with Type 2 diabetes mellitus are a vulnerable population.
Age adjusted mortality rates for diabetes in the predominantly rural state of North
Carolina (NC) are 2.2 times higher for minority males and almost 3 times higher for
minority females than their white counterparts. In rural eastern NC (the proposed
rural region for this investigation) the adjusted mortality rate from diabetes is
42% higher than the rest of the state. Further, Dansky et al (1998) demonstrated
that Medicare beneficiaries with diabetes mellitus in rural communities reported
fewer physician office visits than urban patients while others have shown that low
income, rural patients with diabetes are more likely to receive care from a primary
care physician (our target for intervention) than from a specialist (McCall et al
2004, Woodwell et al 2004).
(reprinted from the grant application of E-Care members to Finding Answers:
Disparities Research for Change)