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CIN Resource Page: Centering Equity in Quality Improvement

As health organizations expand efforts to advance health equity, greater understanding is needed of how to better integrate equity into care improvement initiatives. This resource page from the California Improvement Network (CIN) contains tools, insights, and strategies for how to center equity into existing and new quality improvement efforts in primary care and behavioral health, and provides resources on measuring efforts to improve racial health equity.

Resources listed on this page reflect the focus of a CIN partner meeting and will be periodically updated. Also see the related issue of CIN Connections, Winter 2022.

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To Address Mental Health Care Inequities, Look Beyond Community-Based Programs
This blog states that given the long history of inequity in mental health care and the shift of the public consciousness toward racial injustice and sociopolitical tensions, the field has an opportunity and responsibility to invest in virtual and digitally enabled care to meet the needs of all patients. Learn more about how virtual care is proving to help address disparities in access, cost, and patient experience. (Molly Coye, Health Affairs Blog, September 22, 2021)

An Equity Agenda for the Field of Health Care Quality Improvement
This paper establishes that for health care to be considered high quality, it must be equitable. Two principles are suggested for advancing equity as an essential aim: what gets measured gets improved and that communities’ perspectives, preferences, and goals must be directly integrated into quality improvement efforts. (Margaret O’Kane et al., National Academy of Medicine, September 15, 2021)

A New Effort to Address Racial and Ethnic Disparities in Care Through Quality Measurement
This blog argues that health care providers must quantify gaps in care using equity-focused quality measurement tools in order to provide quality health care regardless of demographic background. Summaries are provided of the current state of race and ethnicity data collection, how the National Committee for Quality Assurance is implementing the Healthcare Effectiveness Data and Information Set, and what other opportunities providers are taking to advance equity. (Rachel Harrington et al., Health Affairs Blog, September 9, 2021)

Developing Health Equity Measures (PDF)
This report identifies, through recommendations from the Centers for Medicare & Medicaid Services, the need to include measures of health equity in public reporting and value-based purchasing through their defined health equity measurement approach. The authors argue that including this approach will increase the focus on improving health for all and help providers prioritize specific areas for quality improvement. (US Dept. of Health and Human Services, May 2021)

CIN Connections, Spring 2021 — Addressing Racism to Improve Health
This issue of CIN Connections contains strategies and reflections from health care leaders as they grapple with how to abolish racism to improve health and remove roadblocks to real health equity; how structural racism impacts health across generations; how health care organizations can work toward becoming actively anti-racist; and how to intentionally design interventions addressing social needs that impact health so that they also address racism as a root cause of poor health. Also see the related resource page. (California Improvement Network, March 2021)

Disparities in Telehealth Use Among California Patients with Limited English Proficiency
Using data from the 2015–18 California Health Interview Survey, this article assesses the use of telehealth (telephone and video visits) by respondents with limited English proficiency, and the impact that use had on health care access and utilization. The authors advise policymakers and clinicians to focus on addressing limited English proficiency as a crucial dimension of equitable telehealth. (Jorge A. Rodriguez et al., Health Affairs, March 2021)

Using Rising Tides to Lift All Boats: Equity-Focused Quality Improvement as a Tool to Reduce Neonatal Health Disparities
This article presents a framework for Equity-Focused Quality Improvement (EF-QI). Learn how EF-QI purposely integrates equity into every stage of improvement projects with the goal of centering the needs of disadvantaged populations and lessening unintentional disparities. (Vicky Reichman et al., Seminars in Fetal and Neonatal Medicine, February 2021)

A Roadmap for Promoting Health Equity and Eliminating Disparities: The Four I’s for Health Equity
A roadmap, developed by a multistakeholder committee convened by National Quality Forum, for reducing health and health care disparities through performance measurement and associated policy mechanisms. In addition to focusing on the US health care system as a way to eliminate disparities, this report also identifies areas for collaborating and developing community partnerships to address health disparities. (National Quality Forum, September 14, 2017).

Achieving Health Equity: A Guide for Health Care Organizations
This paper posits that health care organizations have the power to address disparities directly at the point of care, which can impact the determinants that cause these disparities. Outlined is a five-component framework for improving health equity in communities, guidance for measuring health equity, a case study of how an organization integrated health equity improvement work throughout its system, and a self-assessment tool for gauging current focus on and efforts to improve health equity. (Ronald Wyatt et al., Institute for Healthcare Improvement, 2016)

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