In 1998, the Bureau of Primary Health Care initiated health disparities collaboratives, which enable community health centers (CHCs) and other safety net providers to work together to improve the quality of patient care. The Fund and the Agency for Healthcare Research and Quality are cosponsoring an evaluation of these collaboratives for patients with hypertension, diabetes, and asthma to determine whether they have been effective in reducing disparities. Preliminary findings show that CHCs deliver care of comparable quality to that delivered in other sectors of the health care system, despite the challenges presented by disadvantaged populations.⁽⁵⁾ There is room for improvement, however: quality of care was found to vary by patient as well as health center characteristics, such as use of electronic health records.

To catalyze improvements in the health care received by minority patients in Medicaid managed care plans, the Fund is supporting the Center for Health Care Strategies (CHCS) in the development of the Best Clinical and Administrative Practices (BCAP) initiative. BCAP leaders are identifying highly effective practices used by state Medicaid agencies to improve quality and evaluating federal and state regulations that address racial and ethnic health disparities. They are also working with 12 Medicaid managed care plans in a demonstration project to improve care for minority patients. Best practices and lessons will be posted on the CHCS and Fund Web sites and disseminated to Medicaid agencies and managed care plans through the BCAP Quality Summit.

Much of the literature on health disparities finds that minority patients presenting with the same symptoms and background as white patients are less likely to receive appropriate care for their conditions.⁽⁶⁾ Minority patients are also less likely than white patients to get their care from high-performing health systems, according to a Fund-supported study. Dana Mukamel, Ph.D., from the University of California, Irvine, found that when African Americans saw cardiothoracic surgeons for diagnostic or therapeutic procedures, they were less likely than white patients to go to high-quality hospitals or see high-quality surgeons.⁽⁷⁾ Mukamel also found that after the release of surgeon "report cards" in New York State, black patients' access to the best hospitals and the best providers improved.⁽⁸⁾ Before the reports were available, patients chose surgeons based primarily on observable characteristics, such as years of experience or price; patients' behavior changed, however, with the availability of explicit quality information, such as surgeons' mortality rates for specific procedures.