Changes in disparities following the implementation of a health information technology-supported quality improvement initiative

Abstract

Background: Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities.

Objectives: To examine the effects of a multifaceted, HIT-supported quality improvement initiative on disparities in ambulatory care.

Design: Time series models were used to assess changes in racial disparities in performance between white and black patients for 17 measures of chronic disease and preventive care from February 2008 through February 2010, the first 2 years after implementation of a HIT-supported, provider-directed quality improvement initiative.

Patients: Black and white adults receiving care in an academic general internal medicine practice in Chicago.

Interventions: The quality improvement initiative used provider-directed point-of-care clinical decision support tools and quality feedback to target improvement in process of care and intermediate outcome measures for coronary heart disease, heart failure, hypertension, and diabetes as well as receipt of several preventive services.

Main measures: Modeled rate of change in performance, stratified by race and modeled rate of change in disparities for 17 ambulatory care quality measures

Key results: Quality of care improved for 14 of 17 measures among white patients and 10 of 17 measures among black patients. Quality improved for both white and black patients for five of eight process of care measures, four of five preventive services, but none of the four intermediate outcome measures. Of the seven measures with racial disparities at baseline, disparities declined for two, remained stable for four, and increased for one measure after implementation of the quality improvement initiative.

Conclusions: Generalized and provider-directed quality improvement initiatives can decrease racial disparities for some chronic disease and preventive care measures, but achieving equity in areas with persistent disparities will require more targeted, patient-directed, and systems-oriented strategies.