Journal
MEDICAL CARE
Volume 51, Issue 11, Pages 1020-1026Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0b013e3182a97ba3
Keywords
disparities; quality of care; race; intervention; equity
Categories
Funding
- Robert Wood Johnson Foundation
- National Institute of Diabetes and Digestive and Kidney Diseases [K24 DK071933]
- Chicago Center for Diabetes Translation Research [P30 DK092949]
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Background:A systematic scan of the disparities intervention literature will allow researchers, providers, and policymakers to understand which interventions are being evaluated to improve minority health and which areas require further research.Methods:We systematically categorized 391 disparities intervention articles published between 1979 and 2011, covering 11 diseases. We developed a taxonomy of disparities interventions using qualitative theme analysis. We identified the tactic, or what was done to intervene; the strategy, or a group of tactics with common characteristics; and the level, or who was targeted by the effort.Results:The taxonomy included 44 tactics, 9 strategies, and 6 levels. Delivering education and training was the most common strategy (37%). Within education and training, the most common tactics were education about disease (14%) and self-management (11%), whereas communication skills training (3%) and decision-making aids (1%) were less frequent. The strategy of actively engaging the community through tactics such as community health workers and outreach efforts accounted for 6.5% of tactics. Interventions most commonly targeted patients (50%) and community members who were not established patients of the intervening organization (32%). Interventions targeting providers (7%), the microsystem (immediate care team) (9%), organizations (3%), and policies (0.1%) were less common.Conclusions:Disparities researchers have predominantly focused on the patient as the target for change; future research should also investigate how to improve the system that serves minority patients. Areas for further study include interventions that engage the community, educational interventions that address communication barriers, and the impact of policy reform on disparities in care.
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