Hundreds of research studies have documented the fact that patients from certain racial and ethnic groups are more likely to receive a lower quality of health care. These gaps in treatment, commonly referred to as "racial and ethnic disparities," persist across a range of health care services used to treat different conditions.¹ The Institute of Medicine, one of the foremost independent research institutions in the United States, documented this body of evidence in its landmark report, Unequal Treatment. The evidence of disparities was especially striking in the diagnosis and treatment of cardiovascular disease.²

While racial and ethnic differences in care are well-documented for African Americans, and to a lesser extent, Hispanic and Latino patients, they are less documented for other minority populations. However, disparities in cardiac care have obvious implications for the health, well-being, and life spans of minority populations. Despite technological advances in cardiac care, like the advent of stents, patients from different racial and ethnic backgrounds are not reaping the full benefits of these advances.

The rapid growth in minority populations in the United States underscores the growing importance of focusing on disparities and the quality of care that minority patients receive. Should these gaps in care persist, they will have significant implications for a nation one-half of whose population is expected to be comprised of "minority" residents by the year 2050.³

While finding consistent evidence of disparities in cardiac care, the IOM came to no conclusion as to their causes. The existing research suggests many confounding factors that affect the degree of disparities, such as where patients get their health care and unconscious bias on the parts of patients and providers. And the research does strongly indicate that access-related factors, such as insurance status and ability to pay, are important contributors to disparities in cardiovascular care. However, the vast majority of studies found that disparities persist after variations in insurance status and other factors are taken into account.⁵ Indeed, researchers found evidence of racial and ethnic disparities among Medicare beneficiaries and those cared for by the Veterans' Administration.

Because the problem of racial and ethnic disparities does not suggest one single cause, the IOM report recommended developing comprehensive solutions to the problem. Most health care experts believe that many factors can potentially affect the quality of one’s health care, and therefore, the IOM report recommended a number of clinical and quality related interventions to address racial and ethnic gaps. One of the report’s specific recommendations was that health systems "[p]romote the consistency and equity of care through the use of evidence-based guidelines."⁶

Evidence-based guidelines exist when experts agree what the recommended standard of health care should be for a particular disease or condition. For example, heart attack victims should receive a beta-blocker after an acute episode and patients with diabetes should get a certain number of foot and eye exams each year.

Many entities are involved in trying to improve the quality of health care in this country, like health plans, hospitals, private organizations, and the federal and state governments. Now racial and ethnic disparities are becoming part of the quality improvement movement. The IOM recommended that when health care systems measure the quality of health care services being delivered, they also look at quality by the race and ethnicity of patients. The Expecting Success program is now poised to apply the tools of quality improvement to the challenge of health care disparities.

1. Unequal Treatment, National Academy of Sciences, Washington, DC, 2003, p.1
2. Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence, The Henry J. Kaiser Family Foundation, Menlo Park, CA, 2002, p.1
3. U.S Bureau of the Census, Population projections of the United States by age, sex, race and Hispanic origin: 1995-2050. Revised April 1999
4. Unequal Treatment, National Academy of Sciences, Washington, DC, 2003, p.42
5. Unequal Treatment, National Academy of Sciences, Washington, DC, 2003, p.51
6. Unequal Treatment, National Academy of Sciences, Washington, DC, 2003, p.16