Impact of the HRSA Health Disparities Collaboratives

描述：本申请是应AHRQ （RFA HS-02-005）的要求，要求调查人员评估健康差异协作对参与医疗中心的患者护理过程和结果的影响。我们将研究参与糖尿病II和糖尿病III合作、心血管合作和哮喘I和II合作的健康中心。我们将介绍参与的保健中心实施的干预措施；中心服务的患者群体；中心的结构、人员配备、组织、管理、领导和文化；以及与地方、州和国家组织建立的外部伙伴关系。我们将通过与保健中心和区域集群的主要临床和行政领导人进行访谈来实现这一目标；通过审查保健中心向其分组主任提交的月度报告；并通过审查卫生中心和集群工作人员生成的其他材料。除了使用这些数据来记录医疗中心所取得的成就外，我们还将把它们与从患者医疗记录中收集的有关护理过程和结果的信息结合起来，并解决以下具体目标：1)评估参与健康差异协作是否会改善护理过程和结果。2)确定健康中心的特点，改进团队，以及与护理质量积极变化相关的改进方法。对于每种疾病，我们将对参与协作的15个健康中心进行抽样，并从每个中心参与之前接受治疗的35名患者和参与后接受治疗的35名患者的医疗图表中收集护理过程和结果数据。在这些卫生中心，将对患有其中一种非干预目标疾病的相同数量的患者进行抽样调查。后一组患者将作为我们分析的对照样本之一。此外，从15个没有参与协作但有资格这样做的卫生中心的匹配样本中，我们将从每个中心每种疾病的70名患者的医疗记录中收集数据。这些患者中的一半将被抽样，以配合合作之前的一段时间，另一半将被抽样，以配合合作之后的一段时间。这些患者是我们分析的第二个对照样本。总的来说，我们将研究总共60个保健中心和9,450名患者（每种疾病3,150名）。这项研究的结果将表明，健康差距协作组织是否更接近其提供100%获取和消除差距的目标。

DESCRIPTION: This application is in response to a request by AHRQ (RFA HS-02-005) for investigators to assess the impact of the Health Disparities Collaboratives on the processes and outcomes of care provided to patients cared for at participating health centers. We will study health centers that participated in the Diabetes II and Diabetes III Collaboratives, the Cardiovascular Collaborative, and the Asthma I and II Collaboratives. We will describe the interventions implemented by participating health centers; the patient populations served by the centers; the structure, staffing, organization, management, leadership, and culture of the centers; and the external partnerships formed with local, state, and national organizations. We will achieve this by conducting interviews with key clinical and administrative leaders at the health centers and the regional clusters; by reviewing monthly reports submitted by health centers to their Cluster Directors; and by reviewing other materials generated by staff from health centers and clusters. In addition to using these data to document what the health centers have accomplished, we will combine them with information on the processes and outcomes of care collected from patients' medical records and address the following specific aims: 1)evaluate whether participation in a Health Disparities Collaborative leads to improved processes and outcomes of care. and 2)identify the characteristics of the health centers, improvement teams, and improvement methods associated with positive change in quality of care. For each disease, we will sample 15 health centers that participated in a Collaborative and collect processes of care and outcomes data from the medical charts of 35 patients per center who received care prior to participation and 35 patients per center who received care following participation. The same number of patients with one of the conditions not targeted for intervention will be sampled at each of these health centers. The latter patients will comprise one of the control samples for our analyses. In addition, from a matched sample of 15 health centers that did not participate in a Collaborative, but that are otherwise eligible to do so, we will collect data from medical records of 70 patients per center per condition. Half of these patients will be sampled to coincide with a time period prior to the Collaboratives and half will be sampled to coincide with a period following the Collaboratives. These patients represent a second control sample for our analyses. Overall, we will study a total of 60 health centers and 9,450 patients (3,150 per condition). The results of this study will indicate whether the Health Disparities Collaboratives are nearer their goal of providing 100 percent access and eliminating disparities.