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<span><span><a href="/research/findings/final-reports/learning/learning.pdf">Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities Among Minority Populations </a> [ <img src="/resources/file_logos/pdf.gif" alt="PDF file" title="PDF file" class="icon" /> - 915.1 KB]</span>
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<h1>References</h1>
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<h2>Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities Among Minority Populations</h2> <div id="basic-modal"><!-- start: Basic Modal -->
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<p>Agency for Healthcare Research and Quality. "2003 National Healthcare Quality Report." AHRQ PublicationNo. 05-0013. Rockville, MD: U.S. Department of Health and Human Services, AHRQ, 2003a.</p><p>Agency for Healthcare Research and Quality. "2003 National Healthcare Disparities Report." AHRQ Publication No. 05-0014. Rockville, MD: U.S. Department of Health and Human Services, AHRQ, December 2003b.</p><p>America's Health Insurance Plans. "Health Insurance Plans Address Disparities in Care: Highlights of a 2004 AHIP/RWJF Quantitative Survey Collection and Use of Data on Race and Ethnicity." June 2004.</p><p>Asch, Steven M., Eve A. Kerr, Joan Keesey, John L. Adams, Claude M. Setodji, Shaista Malik, and Elizabeth McGlynn. 2006. "Who Is At Greatest Risk for Receiving Poor-Quality Health Care?" <em>New England Journal of Medicine</em> 354(11):1147-1156.</p><p>Bierman, Arlene, Nicole Lurie, Karen Scott Collins, and John M. Eisenberg. "Addressing Racial and Ethnic Barriers to Effective Health Care: The Need for Better Data." <em>Health Affairs</em> 2002, 21(3): 91-102.</p><p>Burt, Ronald S. <em>Structural Holes: The Social Structure of Competition</em>. Cambridge, MA: Harvard University Press, 1990.</p><p>Clark, Jane Deane, Andrea Kabcenell, and Constance Martin. "Memorandum on Establishing Common Measure for the National Health Plan Collaborative." Princeton NJ: Center for Health Care Strategies, November 3, 2005 (updated April 13, 2006).</p><p>Doreian, Patrick. "Organizational Standing as Social Capital." In <em>Corporate Social Capital</em>, edited by Roger Leenders and Shaul M. Gabbay. Dorrecht, The Netherlands: Kluwer, 1999.</p><p>Doreian, Patrick. "A Revised Measure of Standing of Journals in Stratified Networks." <em>Scientometrics</em> 1987, 11: 71-80.</p><p>Doreian, Patrick. "Measuring Relative Standing in Small Groups and Bounded Social Networks." <em>Social Psychology Quarterly</em> 1986, 49(3): 247-259.</p><p>Fremont, Allen M., Arlene Bierman, Steve L. Wickstrom, Chloe E. Bird, Mona Shah,<br />Jos J. Escarce, Thomas Horstman, and Thomas Rector. "Use of Geocoding in Managed Care Settings to Identify Quality Disparities." <em>Health Affairs</em> 2005, 24(2): 516-526.</p><p>Fremont, Allen, and Nicole Lurie. "The Role of Racial and Ethnic Data Collection in Eliminating Disparities in Health Care." In <em>Eliminating Health Disparities: Measurement and Data Needs</em>, edited by Michele Ver Ploeg and Edward Perrin. Washington, DC: National Academies Press, 2004.</p><p>Gold, Marsha, Erin Fries Taylor, Beth Stevens, So Limpa-Amara, and Patrick Doreian. "Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities among Minority Populations: Program Summary and Evaluation Objectives and Tools that Update the Evaluation Plan of July 8, 2005." Washington, DC: Mathematica Policy Research, Inc., October 2005.</p><p>Gold, Marsha, Erin Fries Taylor, Debra Lipson, Patrick Doreian, Katherine Gruene, and Jennifer Coughlan. "Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities among Minority Populations." Washington, DC: Mathematica Policy Research, Inc., June 2006.</p><p>Gold, Marsha, Erin Fries Taylor, and Tara Krissik. "Analysis of Dissemination and Impact of the Integrated Delivery System Research Network." Washington, DC: Mathematica Policy Research, Inc., December 2004.</p><p>General Accounting Office. "Health Care: Approaches to Address Racial and Ethnic Disparities." Washington, DC: 2003. GAO Report No: GAO-03-862R.</p><p>Hassett, Patricia. "Taking on Racial and Ethnic Disparities in Health Care: The Experience at Aetna." <em>Health Affairs</em> 2005, 24(2): 417-420.</p><p>Health Plan Learning Collaborative Agreement. July 2003.</p><p>Institute of Medicine. <em>Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care</em>, edited by Brian D. Smedley, Adrienne Y. Stith, and Alan R. Nelson. Washington, DC: National Academies Press, 2002.</p><p>Interview with Nicki Lurie. August 2, 2005.</p><p>Koopmans, Lambert. <em>Introduction to Contemporary Statistics</em>, Second Edition. Boston: Duxbury Press, 1987.</p><p>Knoke, David, and James H. Kuklinski. <em>Network Analysis</em>. Sage University Paper Series on Quantitative Applications in the Social Sciences, Series no. 07-028. Newbury Park, CA: Sage Publications, 1982.</p><p>Lurie, Nicole. 2005. "Health Disparitites—Less Talk, More Action." <em>New England Journal of Medicine</em> 353(7):727-729. August 18.</p><p>Memorandum of Participation. July 2004.</p><p>Minutes from senior leadership meeting of the National Health Plan Collaborative. Chicago, June 2005.</p><p>National Research Council. "Eliminating health disparities: measurement and data needs." Ver Ploeg M, Perrin E., editors; National Academies Press; Washington (DC): 2004.</p><p>Nerenz, David R., Vence L. Bonham, Robbya Green-Weir, Christine Joseph, and Margaret Gunter. "Eliminating Racial/Ethnic Disparities in Health Care: Can Health Plans Generate Reports?" <em>Health Affairs</em> 2002 21(3): 259-263.</p><p>Van de Ven, Andrew H., and Diane L. Ferry. <em>Measuring and Assessing Organizations</em>. New York: John Wiley and Sons, 1980.</p><p>Wagner, E.H., R.E. Glasgow, C. Davis, et al. "Quality Improvement in Chronic Illness Care: A Collaborative Approach." <em>Joint Commission Journal on Quality Improvement</em> 2001 27(2): 63-80.</p><p>Wasserman, Stanley, and Katherine Faust. <em>Social Network Analysis: Methods and Applications</em>. Cambridge, England: Cambridge University Press, 1994.</p><h3>Notes</h3><p class="size2"><sup><a id="ref1" name="ref1"></a>1.</sup> To assist in clear presentation of findings, we have taken the liberty of condensing the five evaluation questions into four, and rearranging components of the original questions into groupings that lend themselves better to summarizing the findings for purposes of this Executive Summary.</p><p class="size2"><sup><a id="ref2" name="ref2"></a>2.</sup> Specifically, the third of six areas of interest AHRQ defined for the evaluation asked the evaluator to "measure and assess whether the Collaborative has reduced or eliminated targeted health care disparities experienced by minorities in health plans participating in the Collaborative." We concluded, and AHRQ (and other sponsors and support organizations) agreed that this was unrealistic within the time frame of the Collaborative. The reframed evaluation questions eliminated this area of interest, and took into account AHRQ's desire to avoid burdening participating firms with additional requests for data (Gold et al. 2005).</p><p class="size2"><sup><a id="ref3" name="ref3"></a>3.</sup> Firms generally found our multiple requests for interviews burdensome (especially in round 2, when we requested substantially more interviews). Firms often did not distinguish between requests from the evaluation team and those of the support organizations. They cooperated but asked for fewer demands in the final round of interviews. Their concerns ultimately also will influence the shape of the Phase II evaluations.</p><p class="size2"><sup><a id="ref4" name="ref4"></a>4.</sup> The BCAP initiative encourages plans to organize rapid-cycle quality improvement work around efforts to identify a target population, stratify by risk, reach out to members, and intervene, measuring results to provide formative feedback that can guide future interventions or refinements.</p><p class="size2"><sup><a id="ref5" name="ref5"></a>5.</sup> RAND uses the term "surname" to refer to their use of enrollees' last names to identify those of Hispanic or Asian ethnicity.</p><p class="size2"><sup><a id="ref6" name="ref6"></a>6.</sup> For example, firms that have addressed quality assurance may have many ongoing initiatives. Their approach to disparities could involve building on these efforts to enhance their effectiveness in dealing with disparities.</p><p class="size2"><sup><a id="ref7" name="ref7"></a>7.</sup> One firm used its work with minorities to build grassroots support among community and church leaders. Another firm told us that an RFP issued by the National Business Group on Health in early 2005 had a section asking it to address racial and ethnic disparities as part of the firm's bid. Another firm said that it had a purchaser with a diverse workforce and therefore viewed disparities as a high-priority issue.</p><p class="size2"><sup><a id="ref8" name="ref8"></a>8.</sup> RAND has subsequently refined the method to allow the estimates to reflect uncertainty about the race/ethnicity of members residing in mixed racial/ethnic areas. RAND staff believe this change will lead to better estimates of racial/ethnic composition in heterogenous areas.</p><p class="size2"><sup><a id="ref9" name="ref9"></a>9.</sup> This firm later decided to make use of geocoding and surname analysis to supplement its own data. While these analyses are not specific enough to support member interventions, they provide a vehicle for comparing areas consistently to identify those that might need to be targeted for geographically based interventions. The firm saw this as valuable because reporting was voluntary and could vary by area, and members providing their race/ethnicity were not necessarily representative of all enrollees in an area.</p><p class="size2"><sup><a id="ref10" name="ref10"></a>10.</sup> Several reasons limited our ability to do so. First, AHRQ asked us not to request data from plans, a request most plans would not care to honor in any case because of its burden. Second, the firms are complex organizations whose initiatives do not lend themselves to easy characterization in a telephone interview without supporting documentation. Third, we went into the interviews with limited knowledge of each firm's efforts. While most firms were cooperative—and the technical staff involved in geocoding particularly so—we were covering a broad scope of inquiry and found it challenging to formulate a set of appropriate questions. Fourth, we interviewed staff who often were uncomfortable providing us much detail.</p><p class="size2"><sup><a id="ref11" name="ref11"></a>11.</sup> RAND used what is termed a "deterministic" method of assignment. Members are assigned either as African American or white/other according to whether the proportion of such residents in their census block is above or below 60 percent. "Probabilistic" assignment takes into account uncertainty about what the "true" identifier should be, given the heterogeneity of the population in the census block. RAND says they have now modified its techniques to include probabilistic assignment.</p><p class="size2"><sup><a id="ref12" name="ref12"></a>12.</sup> Though some firms desire RAND to place the tools on the Collaborative web site for their use, we understand that RAND's ability to do so is limited because the tools currently are not set up for easy user interface so doing the conversion would have costs.</p><p class="size2"><sup><a id="ref13" name="ref13"></a>13.</sup> RWJF has done work in this area independent of the Collaborative. For example, RWJF funded a policy brief on the legality of collecting and disclosing patient race and ethnicity data, which was released in June 2006 (www.rwjf.org/files/publications/other/RaceEthnicDisparitiesData06222006.pdf).</p><p class="size2"><sup><a id="ref14" name="ref14"></a>14.</sup> Because communications activities were just beginning during round 2 of our interviews, we did not collect information on communications until round 3.</p><p class="size2"><sup><a id="ref15" name="ref15"></a>15.</sup> All toolkit materials were provided to participating firms in hard copy well as electronically.</p><p class="size2"><sup><a id="ref16" name="ref16"></a>16.</sup> In addition to sharing several copies of the toolkit with each of the participating firms, GMMB has made available selected materials from the NHPC toolkit in a few other forums, such the Alliance for Health Reform briefing on racial/ethnic disparities in December 2005 and a Kaiser Family Foundation briefing on the National Healthcare Disparities Report in April 2006.</p><p class="size2"><sup><a id="ref17" name="ref17"></a>17.</sup> Information on the number of registrants who actually watched the Web cast online is not available.</p><p class="size2"><sup><a id="ref18" name="ref18"></a>18.</sup> In addition, representatives from three firms in the Collaborative are participating in the CHCS Quality Summit on Improving Health Care for Racially and Ethnically Diverse Populations in December 2006. This summit, however, is neither an official Collaborative activity nor sponsored by the Collaborative per se.</p><p class="size2"><sup><a id="ref19" name="ref19"></a>19.</sup> The summary report will likely be disseminated elsewhere as well.</p><p class="size2"><sup><a id="ref20" name="ref20"></a>20.</sup> In summer 2006, GMMB discussed with Collaborative members the possibility of developing several issue briefs on the Collaborative. Lacking much concrete detail to disseminate at this stage, GMMB opted to develop a summary report on the Collaborative instead.</p><p class="size2"><sup><a id="ref21" name="ref21"></a>21.</sup> The analysis was part of the second round of data collection. We originally planned to field it again at the end of the Collaborative, but dropped this plan in response to firms' concern over the burden of participating in the evaluation.</p> </div><!-- end: Basic Modal -->
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<span>Internet Citation: References: Evaluation of a Learning Collaborative's Process and Effectiveness to Reduce Health Care Disparities Among Minority Populations.
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December 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/learning/ref.html</span>
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