Inequality in Quality

Abstract

Socioeconomic and racial/ethnic disparities in health care quality have been extensively documented. Recently, the elimination of disparities in health care has become the focus of a national initiative. Yet, there is little effort to monitor and address disparities in health care through organizational qual- ity improvement. After reviewing literature on disparities in health care, we discuss the limitations in existing quality assessment for identifying and ad- dressing these disparities.Wepropose 5 principles to address these dispari- ties through modifications in quality performance measures: disparities rep- resent a significant quality problem; current data collection efforts are inadequate to identify and address disparities; clinical performance mea- sures should be stratified by race/ethnicity and socioeconomic position for public reporting; population-wide monitoring should incorporate adjust- ment for race/ethnicity and socioeconomic position; and strategies to ad- just payment for race/ethnicity and socioeconomic position should be con- sidered to reflect the known effects of both on morbidity.