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Promoting Healthcare Equity Through Residency Education
This project will explore how healthcare disparities are measured, formally taught by faculty and understood by primary care residents.
In order to prepare future primary clinicians to deliver high-quality, cost-efficient care and reduce socioeconomic disparities, we must help them build advanced skills in quality measurement and population health management. The Meaningful Use EHR incentive program, the Physician Quality Reporting Program, the advent of accountable care organizations, CMS payment for chronic disease and care coordination and other changes included in the MACRA legislation are all advancing models of care aimed at shifting healthcare from volume to value. They aim to improve overall population health and reduce healthcare costs while health systems struggle to keep up with rapid changes in quality measurement and improvement activities. Although some programs have developed curricula for teaching quality improvement during residency, it is not well understood how to best incorporate contemporary developments in the quality improvement landscape into residency training programs.
Contemporary health systems pay inadequate attention to the social determinants of health and the resulting racial and socioeconomic healthcare disparities they produce between groups. Using clinical information systems data to measure disparities in care can guide the selection and implementation of general quality improvement activities and QI strategies to reduce those care disparities. The specific aims in Year 1 are to:
- Develop a methodology for reporting resident-specific data on healthcare disparities in their individual primary care practices
- Review existing curricular models for teaching primary care residents about healthcare disparities and health equity
- Evaluate primary care residents' baseline knowledge and educational needs that we would like to address in our Year 2 educational intervention and to explore primary care residents' reactions
We will calculate at least 16 CMH Physician Quality Reporting Program 2016 measures for a diverse group of adult outpatients who receive care from resident physicians in two programs at Northwestern Medical clinics. The measures will include processes of care related to chronic disease treatment, screening and prevention, and measures of disease control for conditions such as hypertension and diabetes mellitus. We will examine disparities across four domains: race/ethnicity, insurance type, English versus non-English primary language and area-based socioeconomic measures derived from geocoding patient addresses to census track block group characteristics. We will test variations in attribution rules to determine the optimal criteria for determining which patients should be attributed to a resident physician.
We will conduct a systematic narrative review of existing approaches to teaching residents in primary care specialties about health disparities and health equity. The results of the literature review is an important precursor to designing an optimal educational program for residents in Year 2.
Our team will use cross-sectional surveys measuring primary care residents' baseline knowledge, attitudes and perceptions about health disparities and social determinants of health to inform which areas must be emphasized in designing the educational intervention in Year 2. Validated instruments will be used to measure these constructs where available; otherwise, the team will develop novel survey items. The topics covered will include:
- Residents' reactions to their healthcare quality reports stratified by socioeconomic indicators
- Residents' baseline experiences and observations related to healthcare disparities and health equity
- Residents' ideas about what the Year 2 educational intervention should include to prepare them for addressing healthcare disparities and promoting health equity in their primary care practices